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Cost effectiveness of EML4-ALK fusion testing and first-line crizotinib treatment for patients with advanced ALK-positive non-small-cell lung cancer.

https://arctichealth.org/en/permalink/ahliterature104899
Source
J Clin Oncol. 2014 Apr 1;32(10):1012-9
Publication Type
Article
Date
Apr-1-2014
Author
Sandjar Djalalov
Jaclyn Beca
Jeffrey S Hoch
Murray Krahn
Ming-Sound Tsao
Jean-Claude Cutz
Natasha B Leighl
Author Affiliation
Sandjar Djalalov, Jaclyn Beca, and Jeffrey S. Hoch, Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital and Cancer Care Ontario; Sandjar Djalalov, Jaclyn Beca, Jeffrey S. Hoch, Murray Krahn, and Natasha B. Leighl, Canadian Centre for Applied Research in Cancer Control; Murray Krahn, Toronto Health Economics and Technology Assessment Collaborative; Ming-Sound Tsao and Natasha B. Leighl, Ontario Cancer Institute and Princess Margaret Cancer Centre, Toronto; and Jean-Claude Cutz, McMaster University, Hamilton, Ontario, Canada.
Source
J Clin Oncol. 2014 Apr 1;32(10):1012-9
Date
Apr-1-2014
Language
English
Publication Type
Article
Keywords
Antineoplastic Agents - economics - therapeutic use
Carcinoma, Non-Small-Cell Lung - chemistry - drug therapy - economics
Cost-Benefit Analysis
Gene Frequency
Humans
Immunohistochemistry - economics
Lung Neoplasms - chemistry - drug therapy - economics
Neoplasm Staging
Oncogene Proteins, Fusion - analysis - genetics
Ontario
Pyrazoles - economics - therapeutic use
Pyridines - economics - therapeutic use
Quality-Adjusted Life Years
Sensitivity and specificity
Tumor Markers, Biological - analysis
Abstract
ALK-targeted therapy with crizotinib offers significant improvement in clinical outcomes for the treatment of EML4-ALK fusion-positive non-small-cell lung cancer (NSCLC). We estimated the cost effectiveness of EML4-ALK fusion testing in combination with targeted first-line crizotinib treatment in Ontario.
A cost-effectiveness analysis was conducted using a Markov model from the Canadian Public health (Ontario) perspective and a lifetime horizon in patients with stage IV NSCLC with nonsquamous histology. Transition probabilities and mortality rates were calculated from the Ontario Cancer Registry and Cancer Care Ontario New Drug Funding Program (CCO NDFP). Costs were obtained from the Ontario Case Costing Initiative, CCO NDFP, University Health Network, and literature.
Molecular testing with first-line targeted crizotinib treatment in the population with advanced nonsquamous NSCLC resulted in a gain of 0.011 quality-adjusted life-years (QALYs) compared with standard care. The incremental cost was Canadian $2,725 per patient, and the incremental cost-effectiveness ratio (ICER) was $255,970 per QALY gained. Among patients with known EML4-ALK-positive advanced NSCLC, first-line crizotinib therapy provided 0.379 additional QALYs, cost an additional $95,043 compared with standard care, and produced an ICER of $250,632 per QALY gained. The major driver of cost effectiveness was drug price.
EML4-ALK fusion testing in stage IV nonsquamous NSCLC with crizotinib treatment for ALK-positive patients is not cost effective in the setting of high drug costs and a low biomarker frequency in the population.
Notes
Comment In: J Clin Oncol. 2014 Apr 1;32(10):983-524567437
PubMed ID
24567430 View in PubMed
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Genetic testing in combination with preventive donepezil treatment for patients with amnestic mild cognitive impairment: an exploratory economic evaluation of personalized medicine.

https://arctichealth.org/en/permalink/ahliterature118609
Source
Mol Diagn Ther. 2012 Dec;16(6):389-99
Publication Type
Article
Date
Dec-2012
Author
Sandjar Djalalov
Jean Yong
Jaclyn Beca
Sandra Black
Gustavo Saposnik
Zahra Musa
Katherine Siminovitch
Myla Moretti
Jeffrey S Hoch
Author Affiliation
Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
Source
Mol Diagn Ther. 2012 Dec;16(6):389-99
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Amnesia - complications - drug therapy - economics - genetics
Canada
Case-Control Studies
Chemoprevention - economics - methods
Cost-Benefit Analysis
Genetic Testing - economics - methods - utilization
Humans
Indans - economics - therapeutic use
Individualized Medicine - economics - methods
Markov Chains
Mild Cognitive Impairment - complications - drug therapy - economics - genetics
Molecular Targeted Therapy - economics - methods
Nootropic Agents - economics - therapeutic use
Piperidines - economics - therapeutic use
Quality-Adjusted Life Years
Severity of Illness Index
Standard of Care - economics
Abstract
To evaluate the cost effectiveness of genetic screening for the apolipoprotein (APOE) e4 allele in combination with preventive donepezil treatment in comparison with the standard of care for amnestic mild cognitive impairment (AMCI) patients in Canada.
We performed a cost-effectiveness analysis using a Markov model with a societal perspective and a time horizon of 30 years. For each strategy, we calculated quality-adjusted life-years (QALYs), using utilities from the literature. Costs were also based on the literature and, when appropriate, Ontario sources. One-way and probabilistic sensitivity analyses were performed. Expected value of perfect information (EVPI) analysis was conducted to explore the value of future research.
The base case results in our exploratory study suggest that the combination of genetic testing and preventive donepezil treatment resulted in a gain of 0.027 QALYs and an incremental cost of $1,015 (in 2009 Canadian dollars [Can$]), compared with the standard of care. The incremental cost-effectiveness ratio (ICER) for the base case was Can$38,016 per QALY. The ICER was sensitive to the effectiveness of donepezil in slowing the rate of progression to Alzheimer's disease (AD), utility in AMCI patients, and AD and donepezil treatment costs. EVPI analysis showed that additional information on these parameters would be of value.
Using presently available clinical evidence, this exploratory study illustrates that genetic testing combined with preventive donepezil treatment for AMCI patients may be economically attractive. Since our results were based on a secondary post hoc analysis, our study alone is insufficient to warrant recommending APOE genotyping in AMCI patients. Future research on the effectiveness of preventive donepezil as a targeted therapy is recommended.
PubMed ID
23188525 View in PubMed
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Review of Pharmacoeconomic Studies in Russian Cancer Research: An Outside View.

https://arctichealth.org/en/permalink/ahliterature309200
Source
Value Health Reg Issues. 2019 Sep; 19:138-144
Publication Type
Journal Article
Systematic Review
Date
Sep-2019
Author
Sandjar Djalalov
Dilfuza Djalalova
Murray Krahn
Nikolai Matveev
Jeffrey S Hoch
Author Affiliation
Westminster International University in Tashkent, Tashkent, Uzbekistan; Tashkent Pharmaceutical Institute, Tashkent, Uzbekistan; Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada. Electronic address: sandjar.djalalov@yahoo.com.
Source
Value Health Reg Issues. 2019 Sep; 19:138-144
Date
Sep-2019
Language
English
Publication Type
Journal Article
Systematic Review
Keywords
Cost-Benefit Analysis
Databases, Factual
Economics, Pharmaceutical
Humans
Neoplasms
Publications
Quality-Adjusted Life Years
Russia
Abstract
There is an increasing number of Russian economic evaluation studies in oncology, the scope and quality of which are unknown.
This study aimed to assess the scope and quality of economic evaluations in oncology, with the goal of elucidating implications for improving their use in Russia.
Online databases were searched for oncologic economic evaluations written in Russian. Data were extracted and assessed with the Quality of Health Economic Studies (QHES) instrument. In addition, the QHES was modified to overcome double-barreled items in a single criterion.
Of 29 articles identified, 15 met study criteria and were included in the review. Most studies analyzed cost-effectiveness of first- and second-line therapies for lung and kidney cancer. The others analyzed prostate, breast, and colorectal cancers and lymphoma. The QHES mean quality score for the reviewed studies was 74 (and 69 with the modified tool). Comparison of the quality of different study types revealed that cost utility studies and studies that used decision trees and Markov models had the highest mean quality score. Clear statements regarding bias, study limitations, uncertainty, study perspectives, and funding source were commonly absent in the reviewed studies.
Our review indicates that oncologic economic evaluations published in Russian are limited in scope and number. In addition, they demonstrate opportunities for improvement in several important technical areas.
PubMed ID
31472421 View in PubMed
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