Long-Term Effectiveness and Cost Effectiveness of Multiple Myeloma Treatment Strategies for Elderly Transplant-Ineligible Patients in Serbia
| Autor: | Beate Jahn, Igor Stojkov, Wolfgang Willenbacher, Milica Jevđević, Gaby Sroczynski, Uwe Siebert, Đurđa Vukićević, Ursula Rochau, Monika Schaffner, Aleksandar Savic |
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| Rok vydání: | 2020 |
| Předmět: |
Pediatrics
medicine.medical_specialty stroškovna učinkovitost Cost effectiveness zaporedno zdravljenje Transplant ineligible 03 medical and health sciences 0302 clinical medicine Medicine Adverse effect health care economics and organizations Multiple myeloma dolgoročna uspešnost cost effectiveness multipli mielom business.industry Bortezomib 030503 health policy & services Public Health Environmental and Occupational Health medicine.disease Original Scientific Article Term (time) multiple myeloma Clinical trial sequential treatment 030220 oncology & carcinogenesis Life expectancy Public aspects of medicine RA1-1270 0305 other medical science business long-term effectiveness medicine.drug |
| Zdroj: | Slovenian Journal of Public Health, Vol 59, Iss 2, Pp 83-91 (2020) Slovenian Journal of Public Health |
| ISSN: | 1854-2476 |
| DOI: | 10.2478/sjph-2020-0011 |
| Popis: | Evidence on long-term effectiveness and cost effectiveness of treatment sequences for multiple myeloma (MM) is sparse. We used published data and country-specific data to assess the cost effectiveness of four-line treatment sequences for elderly transplant-ineligible patients with MM in Serbia.We developed a Markov cohort model to compare long-term effectiveness and cost effectiveness of five sequential MM treatment alternatives from the perspective of the national healthcare provider. Effectiveness parameters on progression, mortality and adverse events were extracted from published clinical trials. Costs were based on price lists of the National Health Insurance Fund. We compared life expectancy, costs, and incremental cost-effectiveness ratios among alternative courses of action. The model was analyzed over a lifelong time horizon applying a 3% annual discount rate for effectiveness outcomes and costs. Robustness of the model was tested in multiple deterministic sensitivity analyses.The sequences were defined by the frontline treatment: MPT (melphalan-prednisone-thalidomide), MPV (melphalanprednisone-bortezomib), CTD (cyclophosphamide-thalidomide-dexamethasone), VCD (bortezomib-cyclophosphamidedexamethasone) and BP (bendamustine-prednisone). MPV sequence resulted in the highest remaining life expectancy (4.76 life years). Cost-effectiveness analysis resulted in three non-dominated strategies: MPT, VCD, and MPV sequences, with an incremental cost-effectiveness ratio of EUR 35,300 per life-year gained (LYG) for VCD and EUR 47,200/LYG for MPV relative to MPT.MPV sequence was the most effective in terms of life expectancy for elderly transplant-ineligible MM patients in Serbia. Bortezomib-based strategies would be recommended for the frontline treatment of patients with MM in Serbia if the willingness-to-pay threshold is around EUR 35,000-60,000/LYG.O dolgoročni uspešnosti in stroškovni učinkovitosti zaporedij zdravljenja multiplega mieloma (MM) ni veliko dokazov. Na podlagi objavljenih podatkov in podatkov za posamezne države smo ocenili stroškovno učinkovitost štirih zaporedij zdravljenja starejših bolnikov z MM, ki niso primerni za presaditev, v Srbiji.Za primerjanje dolgoročne uspešnosti in stroškovne učinkovitosti petih alternativ zaporednega zdravljenja MM z vidika nacionalnega izvajalca zdravstvenega varstva smo razvili kohortni model Markova. Parametre uspešnosti glede napredovanja, umrljivosti in neželenih dogodkov smo pridobili iz objavljenih kliničnih preskušanj. Stroški temeljijo na cenikih nacionalnega sklada za zdravstveno zavarovanje. Med različnimi ukrepi smo primerjali pričakovano življenjsko dobo, stroške in mejno razmerje stroškovne učinkovitosti. Model smo analizirali v vseživljenjskem časovnem okviru, pri čemer smo za rezultate uspešnosti in stroške uporabili 3-odstotno letno diskontno stopnjo. Robustnost modela smo preizkusili z več determinističnimi analizami občutljivosti.Zaporedja so bila opredeljena z zdravljenjem v prvi liniji: MPT (melfalan-prednizon-talidomid), MPV (melfalanprednizon-bortezomib), CTD (ciklofosfamid-talidomid-deksametazon), VCD (bortezomib-ciklofosfamid-deksametazon) in BP (bendamustin-prednizon). Pri zaporedju MPV je bila pričakovana preostala življenjska doba najdaljša (4,76 leta življenja). Pri analizi stroškovne učinkovitosti so bile ugotovljene tri neprevladujoče strategije: zaporedja MPT, VCD in MPV z mejnim razmerjem stroškovne učinkovitosti 35.300 EUR na pridobljeno leto življenja (LYG) za VCD in 47.200 EUR/LYG za MPV glede na MPT.Zaporedje MPV je bilo najuspešnejše v smislu pričakovane življenjske dobe starejših bolnikov z MM, ki niso primerni za presaditev, v Srbiji. Strategije, ki temeljijo na bortezomibu, bi bile priporočljive za zdravljenje bolnikov z MM v prvi liniji v Srbiji, če je prag pripravljenosti na plačilo približno 35.000–60.000 EUR/LYG. |
| Databáze: | OpenAIRE |
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