Expert Review of Pharmacoeconomics & Outcomes Research

The socioeconomic burden of cervical cancer and its implications for strategies required to achieve the WHO elimination targets

Cervical cancer is almost entirely preventable by vaccination and screening. Population-based vaccination and screening programs are effective and cost effective, but millions of people do not have access to these programs, causing immense suffering. The WHO Global Strategy for the elimination of cervical cancer as a public health problem calls for countries to meet ambitious vaccination, screening, and treatment targets. Epidemiological evidence indicates marked socioeconomic gradients in the burden of cervical cancer and vaccination, screening, and treatment coverage. The unacceptable socioeconomic burden of cervical cancer is largely a function of inequitable access to these programs. We discuss these inequities, and highlight strategies enabled by new evidence and technology. Single dose HPV vaccination, HPV-based screening, and the rapidly moving technology landscape have enabled task-shifting, innovation in service delivery and the possibility of scale. Equitable access to optimal care for the treatment of invasive cancers remains a challenge. Cervical cancer can be eliminated equitably. It will require global political will, sustained public and private investment, and community leadership to safely and sustainably embed proven tools, technology and infrastructure in local health and knowledge systems.

Cost-effectiveness of olaparib maintenance therapy when used with and without restriction by BRCA1/2 mutation status for platinum-sensitive relapsed ovarian cancer

Cost-effectiveness analysis of olaparib and niraparib as maintenance therapy for women with recurrent platinum-sensitive ovarian cancer

We evaluated the cost-effectiveness of olaparib and niraparib as maintenance therapy for patients with platinum-sensitive recurrent ovarian cancer. In the base case, olaparib was the more cost-effective treatment regimen. The ICERs for olaparib and niraparib compared to placebo were NT$1,804,785 and NT$2,340,265 per PFS-LY, respectively. Tornado analysis showed that PFS and the total resource use cost of niraparib regimen for patients without Olaparib was estimated to be less cost and more effective compared to niraparib as maintenance therapy for patients with recurrent platinum-sensitive ovarian cancer.

A comparison of six approaches for measuring utility values among patients with locally advanced cervical cancer

Several instruments are available to measure health utility values. However, limited studies have not yet comprehensively assessed the agreement among these instruments. This study therefore aimed to investigate the performance and agreement of six instruments for utility measures: EQ-5D-3L, EQ-5D-5L (cTTO model), EQ-5D-5L (DCE model), EQ-5D-5L (Hybrid model), TTO, and VAS, among locally advanced cervical cancer (LACC) patients in Thailand. We compared utility scores derived from six approaches using Friedman's test. We also assessed the agreement of utility scores between each pairwise comparison by intraclass correlation coefficient (ICC) and Bland-Altman plot. The mean (SD) utility values derived from six approaches were as follows: 0.755 ± 0.248 (EQ-5D-3L), 0.801 ± 280 (TTO), 0.806 ± 0.156 (VAS), 0.871 ± 0.184 (cTTO model), 0.875 ± 0.168 (Hybrid model), and 0.900 ± 0.142 (DCE model). Significant differences across six approaches were found in Friedman's test. The ICC showed high agreement between EQ-5D-5L and EQ-5D-3L, and very high agreement between all three models of EQ-5D-5L. The Bland-Altman plots showed wide limit of agreement, except the pairwise comparison, between each model of the EQ-5D-5L. TTO, VAS, EQ-5D-3L and EQ-5D-5L could not be used interchangeably in LACC patients. The impact of using different instruments on economic evaluation findings warrants further investigation.

Cost-effectiveness of durvalumab with or without olaparib as a first-line treatment for dMMR type of advanced/recurrent endometrial cancer

In the phase III DUO-E trial, durvalumab with or without olaparib significantly increased survival outcomes compared to chemotherapy alone among patients with endometrial cancer. The aim of this study was to assess the cost-effectiveness of durvalumab in patients with advanced/recurrent dMMR endometrial cancer. A Markov model was used to compare the cost-effectiveness of durvalumab with or without olaparib compared to chemotherapy alone in the treatment of advanced/recurrent dMMR endometrial cancer, using the data from phase III DUO-E trial. The outcomes evaluated were total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICER). One-way sensitivity and probabilistic sensitivity analyses were performed to account for uncertainty. The base case analysis found that durvalumab and chemotherapy had an ICER of $239,884/QALY, whereas durvalumab with olaparib and chemotherapy had an ICER of $259,651/QALY compared to chemotherapy alone. The model was most sensitive to the cost of durvalumab. Probabilistic sensitivity analysis revealed that durvalumab had a 0% likelihood of being considered cost effective at a WTP threshold of $150,000 per QALY. Durvalumab was not cost-effective as a first-line treatment of patients with advanced/recurrent dMMR subtype of endometrial cancer. Reducing the cost of durvalumab might improve economic outcomes.

Cost-effectiveness of second- or third-line treatment with tisotumab vedotin for metastatic or recurrent cervical cancer

To evaluate the cost-effectiveness of tisotumab vedotin (TV) versus single-agent chemotherapy in recurrent or metastatic cervical cancer (r/mCC) after failure of first-line treatment, from the perspective of the Spanish National Health System. Cost-utility analysis was conducted using a partitioned survival model with three health states, over a 60-month time horizon. Efficacy data ‒overall survival (OS) and progression free survival‒ were derived from innovaTV-301 trial and modeled using parametric survival functions. Costs and utilities were obtained from national databases and literature, with outcomes expressed in quality-adjusted life years (QALYs). Incremental cost-utility ratio (ICUR) was calculated, and sensitivity analyses were performed to explore uncertainty. TV provided an additional 0.341 QALYs over chemotherapy (1.229 vs. 0.889) at an incremental cost of €12,138, resulting in an ICUR of €35,600/QALY, assuming a cost equivalent to cemiplimab. Sensitivity analyses showed ICURs ranging from €33,483-€37,564/QALY depending on modeling assumptions. Drug price and OS benefit were the most influential parameters. Using the foreign list price for TV, the ICUR increased to €950,017/QALY. TV offers a modest benefit over chemotherapy in r/mCC and reaches or surpasses the upper bounds of ICER applied in Spain when priced comparably to cemiplimab. The magnitude of clinical benefit remains uncertain.

Hospital care of endometriosis in Spain: a retrospective multicenter analysis of patient characteristics and costs

Despite the potential serious outcomes associated with endometriosis, few data is available describing the real clinical practice and costs. The aim of this study was to evaluate the characteristics of patients diagnosed with endometriosis in Spain, to measure incidences within the hospital setting and the associated medical costs. Data corresponded primarily to inpatient admissions, with a median length of stay of 3 days. Length of stay correlated with patients' age. Admissions were mainly associated with surgical procedures, namely local excision or destruction of lesions. The majority of secondary diagnoses registered corresponded to inflammatory disease of female pelvic organs; 9.2% of patients presented neoplasms of uterus and only 0.9% registered ovarian neoplasms. Mean admission cost was €3566 over the study period. The majority of admissions reviewed in this study corresponded to the removal of ovarian lesions, although data suggested a decrease in the number of cases that were treated as hospital inpatient admissions over the study period. Older patients, surgical procedures, and lengthier admissions were associated with higher medical costs.

The economic value of knowing BRCA status: BRCA testing for optimizing treatment in recurrent epithelial ovarian cancer

This study aimed to estimate the incremental lifetime effects, costs, and net monetary benefit (NMB) of knowing Incremental NMB (INMB) was calculated as the average net monetized benefit of knowing Knowing BRCA information for ROC patients provided an additional monetized value of $3,528 in (payer) and $3,194 (society). Escalated to all ROC patients in the U.S. and future incidence ROC estimates, knowing The economic value of knowing

Cost-effectiveness and drug wastage of bevacizumab biosimilar with or without chemotherapy for platinum-resistant recurrent ovarian cancer

The cost-effectiveness of adding bevacizumab biosimilar with or without chemotherapy (CT) and drug wastage in treating platinum-resistant recurrent ovarian cancer (PRrOC) was assessed. A three-state partitioned-survival model to compare the clinical and economic outcomes in the treatment of patients with PRrOC from a Taiwan healthcare prospective, extrapolated to two years based on data obtained from the JGOG3023 clinical trial. The primary outcomes of the model were incremental cost-effectiveness ratios (ICERs). In the base-case scenario, using vials of bevacizumab biosimilar (Bevbiol) plus chemotherapy, the ICER was (new Taiwan dollar) NT$ 4,555,878 per QALY gained. The incremental cost savings of an incremental 2.02 QALYs were NT$ 1,605,828 if weight-based Bevbiol plus chemotherapy were used, but the ICER remained high at the willingness-to-pay (WTP) threshold. If the cost of Bevbiol were reduced to 50% per vial, adding it to CT would be cost-effective at an acceptable WTP threshold of NTD 2,994,200, with an ICER of NT$ 2,975,484. Bevacizumab biosimilars in mg/kg dosage form with chemotherapy are still not cost-effective in Taiwan, but using weight-based dosing will reduce drug waste and save treatment costs.