lindsay hedden priorities 2010 boston ma n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Lindsay Hedden Priorities 2010, Boston, MA PowerPoint Presentation
Download Presentation
Lindsay Hedden Priorities 2010, Boston, MA

Loading in 2 Seconds...

play fullscreen
1 / 20

Lindsay Hedden Priorities 2010, Boston, MA - PowerPoint PPT Presentation


  • 95 Views
  • Uploaded on

An Application of Evidence-Based Marginal Analysis: Assessing the Incremental Cost Effectiveness of Eras of Metastatic Colorectal Cancer Therapy in British Columbia, Canada: Pre- and Post- Bevacizumab Introduction . Lindsay Hedden Priorities 2010, Boston, MA.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

Lindsay Hedden Priorities 2010, Boston, MA


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
lindsay hedden priorities 2010 boston ma

An Application of Evidence-Based Marginal Analysis: Assessing the Incremental Cost Effectiveness of Eras of Metastatic Colorectal Cancer Therapy in British Columbia, Canada: Pre- and Post-Bevacizumab Introduction

Lindsay Hedden

Priorities 2010, Boston, MA

priority setting and resource allocation at bcca
Priority Setting and Resource Allocation at BCCA
  • This bevacizumab study is part of a larger program of research into Evidence Based Marginal Analysis
    • Goal: to develop and pilot novel evidence-based methods for priority setting and resource allocation within the context of cancer control and care in British Columbia
  • A key objective: evaluate the effectiveness of priority setting decisions using utilization, mortality, and quality of life data
emba study structure
EMBA Study Structure

STEERING COMMITTEE

  • Established and refined decision criteria
  • Identified three areas for potential resource reallocation
  • Reviewed results of cost-effectiveness analyses
  • Made recommendations for resource reallocation

PROGRAM PANELS

  • Provide clinical and data expertise on model building
  • Validate results
bevacizumab avastin background
Bevacizumab (Avastin): Background
  • Bevacizumab (bev): given as a first- or second-line systemic therapy in combination with other regimens to treat metastatic colorectal cancer (mCRC)
    • 2.8 month average improvement in overall survival
    • 2.6 months average improvement in progression-free survival
  • National Institute for Health and Clinical Excellence (UK)
    • £62,857-£88,436 per QALY gained
    • Use of bev as first-line therapy is NOT recommended
slide5
Goal

To estimate the incremental cost-effectiveness of bevas a systemic therapy treatment for mCRC, accounting for the differences in costs and health outcomes associated with bevand standard of care treatments

BUT: Cannot directly compare costs and outcomes for patients treated vs. not treated with bevacizumab because of selection bias

approach and objectives
Approach and Objectives
  • Compare eras of treatment for mCRC:
    • pre-bevacizumab introduction and post-bevacizumab introduction
    • secondary pseudo case-control comparison
  • Objectives
    • 1) To assess the cost-effectiveness of the era of bev protocols in the treatment of mCRC compared with the pre-bev era
    • 2)to evaluate the incremental cost-effectiveness of a first- and second-line bevamong the subset of patients receiving “doublet” chemotherapy (5-FU plus irinotecan or oxaliplatin)
sample
Sample
  • Complete cohort of patients presenting with mCRC at diagnosis, identified using BCCA’s Information Service (CAIS)
    • Pre-era: Diagnosed Jan 1, 2003-Dec 31, 2004; followed to death, censoring, or Oct 31, 2005
    • Bev-era: Diagnosed Jan 1, 2006-Dec 31, 2006; followed to death, censoring, or Oct 31, 2008
  • 611 cases in pre-era & 332 in the post-era
transition probabilities
Transition Probabilities

Survival: derived based on Weibull models

Chemotherapy: derived based on Exponential models

utility values
Utility Values

*Source: Ness, R.M., et al., Outcome states of colorectal cancer: identification and description using patient focus groups. The American Journal of Gastroenterology, 1998. 93(9): p. 1491-1497

restricted analysis
Restricted Analysis
  • Subset of era-based analysis:
    • 1) Diagnosed before age 70
    • 2) Treated with first-line doublet chemotherapy
  • Intent: include only patients who wereorwould have been eligible for a bev-based protocol
interpretation
Interpretation
  • Era-based: $62,468.68/QALY or $15,617/LYG 3.9 month/patient improvement in survival & $3,791/patient increase in cost
    • Not directly inferred as cost-effectiveness of bev
      • Other factors my have led to improvements in survival, increases in cost
interpretation 2
Interpretation (2)
  • Restricted Analysis: $43,058/QALY or $10,764/LYG  4.4 month/patient improvement in survival & $1,894/patient increase in cost
    • Closer to a true incremental cost-effectiveness comparing bev with standard of care, but not perfect
  • Both methods produced ICERs demonstrating better cost-effectiveness than estimated by NICE
implications
Implications
  • As a 1st or 2nd line treatment for mCRC, bev may be relatively cost-effective, considered as part of a suite of available treatments
    • the era-based ICER of $62,468 is well in-line with cost-effectiveness ratios reported for other therapies for metastatic cancer therapies
acknowledgements
Acknowledgements
  • Project team:
    • Dr. Stuart Peacock
    • Dr. Diego Villa
    • Dr. Hagen Kennecke
  • Funding sources:
    • CIHR Partnerships in Health Systems Improvement