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Health Care Resource Utilization among Advanced Melanoma Patients in Europe
A156
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
supportive care (BSC) and died. Patient characteristics, treatment outcomes, costs and HRU were collected retrospectively from the beginning of the last completed treatment line onwards, for patients receiving: second- or third-line lenalidomide or bortezomib; fourth-line lenalidomide, bortezomib or bendamustine; any regimen as fifth line or greater; BSC only. Specific costs were obtained from the Italian Drug Agency, the Ministry of Health and Codifa. Costs of other drugs and resources (e.g. hospitalisation and laboratory tests) were estimated based on standardised schedules. Results: Physicians (n= 57) provided data on patients receiving active treatment (n= 355) or BSC (n= 38). The mean (standard deviation [SD]) duration of a therapy line (second to fourth line) was 15.6 (15.9) months (active treatment: 9.0 (7.9) months; treatment-free interval before progression: 6.6 (13.5) months). The mean total cost (SD) per treatment line was € 38,402 (42,569); most costs were attributable to anti-tumour drugs (94.2%). The cost of managing adverse events (AEs) ranged from € 79 to € 4,415 per event. Excluding anti-tumour drugs and managing AEs, costs were incurred by laboratory tests (30% of total cost), hospitalisation (27%), concomitant medication (26%), procedures (10%) and outpatient consultations (7%). The mean total cost (SD) for BSC was € 3,169 (3969) for patients who progressed following discontinuation of active treatment and € 2,485 (3844) for those who did not progress before death. Conclusions: In Italy, management of patients with relapsed MM is expensive. Most costs result from anti-tumour drugs and AE management, and the remainder are attributable to laboratory tests, hospitalisation and concomitant medication. PCN124 Chart Review Study to Evaluate Health Care Resource Utilization of Patients with Symptomatic Multiple Myeloma in the United Kingdom Gonzalez-McQuire S1, Yong K2, Flinois A3, Gazzola C3, Schoen P1, Campioni M1, DeCosta L4, Fink L3 1Amgen (Europe) GmbH, Zug, Switzerland, 2University College London, London, UK, 3Kantar Health, Paris, France, 4Amgen Ltd., Uxbridge, UK
Objectives: To evaluate the cost of care of patients with symptomatic multiple myeloma (MM) in the United Kingdom (UK). Methods: Oncologists and haematologists completed case report forms for patients who, in the 3 months before study initiation, either progressed after receiving specific treatment regimens (those most commonly prescribed) or received best supportive care (BSC) and died. Patient characteristics, treatment outcomes, costs and healthcare resource utilisation were collected retrospectively from the beginning of the last completed line of treatment onwards, for patients receiving: second-line lenalidomide or bortezomib; thirdline lenalidomide; fourth-line lenalidomide, pomalidomide or bendamustine; any regimen as fifth line or greater; BSC only. Specific costs were obtained from the UK Department of Health and MedicinesComplete. The costs of other drugs and resources (e.g. hospitalisation and laboratory tests) were estimated based on standardised schedules. Results: Physicians (n= 56) provided data on patients receiving active treatment (n= 346) and BSC (n= 41). The mean (standard deviation [SD]) duration of a treatment (DoT) line (second to fourth line) was 11.8 (8.6) months (active treatment: 7.9 [6.4] months; treatment-free interval before progression: 3.9 [6.3] months). The mean (SD) total cost per treatment line was £34,296 (30,555) and the mean (SD) cost per month during active treatment was £5,168 (4,151). The mean (SD) total cost of BSC was £1,444 (2,831) for patients who progressed following active treatment discontinuation and £2,485 (3,844) for those who did not progress before death. The mean (SD) total costs of managing patients with the standard regimen of bortezomib and lenalidomide (second and third lines) were £18,456 (7364) and £42,780 (37,690), respectively (mean [SD] durations of treatment line, 13.1 [8.8] and 15.1 [11.0] months, respectively; mean total combined cost, £59,423). Conclusions: The DoT across lines was less than one year, illustrating that MM remains difficult to treat. Treatment is associated with high costs. PCN125 Health Care Resource Utilization among Advanced Melanoma Patients in Europe Sheahan K1, Zagorska A2, Kotapati S3, Le T4, Mathias SD5 1Bristol Myers Squibb, Princeton, NJ, USA, 2Bristol-Myers Squibb, Rueil Malmaison, France, 3Bristol-Myers Squibb, Princeton, NJ, USA, 4Bristol-Myers Squibb, Hopewell, NJ, USA, 5Health Outcomes Solutions, Winter Park, FL, USA
Objectives: Health care resource utilization (HCRU), including inpatient and outpatient visits, was analyzed to better understand resource consumption in real world settings among advanced melanoma patients in Europe. Methods: IMAGE is an observational, multinational, prospective study focusing on treatment of patients with advanced melanoma. Treatment may include ipilimumab or any other treatment approved for advanced melanoma. As of March 24, 2015, 1280 patients in North and South America, Europe, Australia, and Israel were enrolled. Sub-analysis of all patients in 9 European countries (N= 1004) was conducted to reflect regional HCRU. Results: Ninety–six percent of patients had Stage IV melanoma upon enrollment. Ninety percent (n= 906) had at least one melanoma-related healthcare visit during the study period (from enrollment to analysis). Among patients with melanoma related visits, 87% had at least one outpatient clinic visit, 54% were hospitalized (some patients experienced both hospitalization and outpatient visits). The total number of melanoma-related outpatient visits was 8553 (based on 6 month mean follow-up). Primary reasons for outpatient visits include management of melanoma (89% of visits), treatment-related adverse events (5%), and surgical intervention (1%). For ipilimumab patients (n= 851), the mean number of outpatient visits was 9.6. Forty-seven percent had a melanoma-related hospitalization or hospice visit. The mean number of hospitalizations or hospice visits was 3.2, and the mean number of inpatient days was 19.3. For non-ipilimumab patients, the mean number of outpatient visits was 8.6. Seventy-one percent had a melanoma-related hospitalization or hospice visit. The mean number of hospitalizations or hospice visits was 4.5, and the mean number of inpatient days was 18.9. Conclusions: Advanced melanoma is a significant health condition associated with high HCRU.
Current data suggest that melanoma-related HCRU (hospice visits and hospitalization) is lower among ipilimumab patients than those receiving other approved treatments. Future analyses will present data for longer follow up and larger sample size. PCN126 Relative Value Assessment: Characterizing the Benefit of Oncology Therapies Through Diverse Metrics Macaulay R1, Farrimond B1, Ahuja A2, Ademisoye E1, Shaw J3, Orsini L3 Consulting, London, UK, 2PAREXEL Access Consulting, Chandigarh, India, 3Bristol-Myers Squibb, Princeton, NJ, USA
1PAREXEL Access
Objectives: The unmet need for oncology therapies is substantial. The introduction of innovative, high-cost treatments, coupled with mounting budgetary pressures, will necessitate value trade-offs across cancer types. Defining value will be critical to informing decision-making. Relative value assessment was conducted using a diverse set of outcome metrics and treatment costs for a variety of metastatic cancers. Methods: A review of sources published between 1/1/2000-11/30/2015 identified outcomes data for approved treatments for metastatic cancers. Data were extracted or derived for median and mean OS, milestone survival rates, and other outcomes metrics. Relative outcomes were compared across treatments with and without consideration of costs. In cost-outcome analyses, the cost per given survival benefit identified agents with the highest relative value. Results: Survival metric results varied by agent within cancer type. For instance, when used for treating NSCLC, nivolumab yielded the highest improvement in mean OS (4.1 months, pretreated squamous disease) and 1-year survival rate (10.8 percentage points, pretreated non-squamous disease), whereas afatinib yielded the highest median OS improvement (4.1 months, 1st-line EGFR Del19 and L858R mutants). For treatment of prostate cancer, abiraterone yielded the highest improvement in 1-year survival rate (14.4 percentage points, pre-treated), while enzalutamide yielded the highest median OS improvement (4.8 months, pre-treated) and sipuleucel-T the highest mean OS improvement (3.6 months, 1st-line). Results of cost-value analyses varied with the applied metric as some agents achieved a higher cost-value with some metrics but not with others. Conclusions: Valuing oncology therapies based on improvements in median OS yields distinct results versus other survival metrics. Unlike other metrics, median OS fails to account for long-term survival benefits. Other frameworks developed for assessing the value of oncology therapies (e.g., ASCO, ESMO) are driven by median OS/PFS benefits and may not adequately value long-term survival, which is the ultimate goal of cancer treatment.
CANCER – Patient-Reported Outcomes & Patient Preference Studies PCN127 Economic Burden due to Treatment Non-Adherence in Patients with Breast Cancer: A Systematic Review Gupta J1, Joshi P2, Kamra S2, Sehgal M2 International, New Delhi, India, 2PAREXEL International, Chandigarh, India
1PAREXEL
Objectives: Adherence to oral medications among patients with breast cancer (BC) has been reported to be suboptimal. We conducted a systematic literature review to assess the economic burden due to treatment non-adherence among patients with BC. Methods: Embase® and MEDLINE® were searched for the relevant studies published post 2005. Each citation was reviewed by two independent reviewers; any disagreement was resolved by a third reviewer. Results: Of the 595 citations obtained from the database search, three studies met the inclusion criteria. Adherence to hormone therapy (two studies) was measured by proportion of days covered and to lapatinib (one study) by medication possession ratio, time to treatment interruption/discontinuation and time to end of continuous treatment. The proportion of non-adherent patients ranged from 22% to 46% across the included studies. In an economic evaluation, low adherence to tamoxifen was found to be associated with an increased discounted medical cost of £5,970 (95%CI: £4,644–£7,372) over an average patient’s lifetime. This study used data for women with incident BC between 1993 and 2000 in the Tayside region of Scotland. Key contributors to increased cost were in-patient stay and other dispensing costs. Similarly, among patients with non-metastatic BC, medical costs in the adherent group with tamoxifen and aromatase inhibitors appeared to be lower than in the non-adherent group during the 4-year study period (difference between non-adherent and adherent: $1,476 [year 1], $8,008 [year 2], $-290 [year 3], and $1,857 [year 4]). Adjusted medical costs were reported to be 31% less for adherent cohort. Among women with metastatic BC, a statistically non-significant association was reported between non-adherence to lapatinib and total healthcare costs (p= 0.870). Conclusions: Limited published evidence suggested that treatment non-adherence tends to increase medical and overall healthcare costs in BC. Improvement in adherence can help in reducing the economic burden in long-term and improve cost-effectiveness. PCN128 A Systematic Review to Assess the Impact of Non-Adherence to Treatments on Health Care Cost in Chronic Myeloid Leukemia Gupta J1, Kamra S2, Joshi P2, Sehgal M2 International, New Delhi, India, 2PAREXEL International, Chandigarh, India
1PAREXEL
Objectives: To assess the cost implications of non-adherence to treatment among the patients with chronic myeloid leukemia (CML). Methods: Relevant English-language studies were searched from Embase® and MEDLINE®. Two independent reviewers reviewed each study and any disagreement was resolved by third reviewer. Results: Six out of 216 studies were included. All studies were retrospective in design and utilized medication possession ratio (MPR) to measure adherence except one, which utilized proportion of days covered. Treatments assessed included imatinib in four studies and dasatinib, imatinib, and nilotinib in two studies. Percentage of non-adherent patients ranged from 14% with dasatinib to 66% with imatinib. Across the studies, higher adherence was associated with lower total healthcare cost including medical, inpatient, and outpatient cost. In the
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
supportive care (BSC) and died. Patient characteristics, treatment outcomes, costs and HRU were collected retrospectively from the beginning of the last completed treatment line onwards, for patients receiving: second- or third-line lenalidomide or bortezomib; fourth-line lenalidomide, bortezomib or bendamustine; any regimen as fifth line or greater; BSC only. Specific costs were obtained from the Italian Drug Agency, the Ministry of Health and Codifa. Costs of other drugs and resources (e.g. hospitalisation and laboratory tests) were estimated based on standardised schedules. Results: Physicians (n= 57) provided data on patients receiving active treatment (n= 355) or BSC (n= 38). The mean (standard deviation [SD]) duration of a therapy line (second to fourth line) was 15.6 (15.9) months (active treatment: 9.0 (7.9) months; treatment-free interval before progression: 6.6 (13.5) months). The mean total cost (SD) per treatment line was € 38,402 (42,569); most costs were attributable to anti-tumour drugs (94.2%). The cost of managing adverse events (AEs) ranged from € 79 to € 4,415 per event. Excluding anti-tumour drugs and managing AEs, costs were incurred by laboratory tests (30% of total cost), hospitalisation (27%), concomitant medication (26%), procedures (10%) and outpatient consultations (7%). The mean total cost (SD) for BSC was € 3,169 (3969) for patients who progressed following discontinuation of active treatment and € 2,485 (3844) for those who did not progress before death. Conclusions: In Italy, management of patients with relapsed MM is expensive. Most costs result from anti-tumour drugs and AE management, and the remainder are attributable to laboratory tests, hospitalisation and concomitant medication. PCN124 Chart Review Study to Evaluate Health Care Resource Utilization of Patients with Symptomatic Multiple Myeloma in the United Kingdom Gonzalez-McQuire S1, Yong K2, Flinois A3, Gazzola C3, Schoen P1, Campioni M1, DeCosta L4, Fink L3 1Amgen (Europe) GmbH, Zug, Switzerland, 2University College London, London, UK, 3Kantar Health, Paris, France, 4Amgen Ltd., Uxbridge, UK
Objectives: To evaluate the cost of care of patients with symptomatic multiple myeloma (MM) in the United Kingdom (UK). Methods: Oncologists and haematologists completed case report forms for patients who, in the 3 months before study initiation, either progressed after receiving specific treatment regimens (those most commonly prescribed) or received best supportive care (BSC) and died. Patient characteristics, treatment outcomes, costs and healthcare resource utilisation were collected retrospectively from the beginning of the last completed line of treatment onwards, for patients receiving: second-line lenalidomide or bortezomib; thirdline lenalidomide; fourth-line lenalidomide, pomalidomide or bendamustine; any regimen as fifth line or greater; BSC only. Specific costs were obtained from the UK Department of Health and MedicinesComplete. The costs of other drugs and resources (e.g. hospitalisation and laboratory tests) were estimated based on standardised schedules. Results: Physicians (n= 56) provided data on patients receiving active treatment (n= 346) and BSC (n= 41). The mean (standard deviation [SD]) duration of a treatment (DoT) line (second to fourth line) was 11.8 (8.6) months (active treatment: 7.9 [6.4] months; treatment-free interval before progression: 3.9 [6.3] months). The mean (SD) total cost per treatment line was £34,296 (30,555) and the mean (SD) cost per month during active treatment was £5,168 (4,151). The mean (SD) total cost of BSC was £1,444 (2,831) for patients who progressed following active treatment discontinuation and £2,485 (3,844) for those who did not progress before death. The mean (SD) total costs of managing patients with the standard regimen of bortezomib and lenalidomide (second and third lines) were £18,456 (7364) and £42,780 (37,690), respectively (mean [SD] durations of treatment line, 13.1 [8.8] and 15.1 [11.0] months, respectively; mean total combined cost, £59,423). Conclusions: The DoT across lines was less than one year, illustrating that MM remains difficult to treat. Treatment is associated with high costs. PCN125 Health Care Resource Utilization among Advanced Melanoma Patients in Europe Sheahan K1, Zagorska A2, Kotapati S3, Le T4, Mathias SD5 1Bristol Myers Squibb, Princeton, NJ, USA, 2Bristol-Myers Squibb, Rueil Malmaison, France, 3Bristol-Myers Squibb, Princeton, NJ, USA, 4Bristol-Myers Squibb, Hopewell, NJ, USA, 5Health Outcomes Solutions, Winter Park, FL, USA
Objectives: Health care resource utilization (HCRU), including inpatient and outpatient visits, was analyzed to better understand resource consumption in real world settings among advanced melanoma patients in Europe. Methods: IMAGE is an observational, multinational, prospective study focusing on treatment of patients with advanced melanoma. Treatment may include ipilimumab or any other treatment approved for advanced melanoma. As of March 24, 2015, 1280 patients in North and South America, Europe, Australia, and Israel were enrolled. Sub-analysis of all patients in 9 European countries (N= 1004) was conducted to reflect regional HCRU. Results: Ninety–six percent of patients had Stage IV melanoma upon enrollment. Ninety percent (n= 906) had at least one melanoma-related healthcare visit during the study period (from enrollment to analysis). Among patients with melanoma related visits, 87% had at least one outpatient clinic visit, 54% were hospitalized (some patients experienced both hospitalization and outpatient visits). The total number of melanoma-related outpatient visits was 8553 (based on 6 month mean follow-up). Primary reasons for outpatient visits include management of melanoma (89% of visits), treatment-related adverse events (5%), and surgical intervention (1%). For ipilimumab patients (n= 851), the mean number of outpatient visits was 9.6. Forty-seven percent had a melanoma-related hospitalization or hospice visit. The mean number of hospitalizations or hospice visits was 3.2, and the mean number of inpatient days was 19.3. For non-ipilimumab patients, the mean number of outpatient visits was 8.6. Seventy-one percent had a melanoma-related hospitalization or hospice visit. The mean number of hospitalizations or hospice visits was 4.5, and the mean number of inpatient days was 18.9. Conclusions: Advanced melanoma is a significant health condition associated with high HCRU.
Current data suggest that melanoma-related HCRU (hospice visits and hospitalization) is lower among ipilimumab patients than those receiving other approved treatments. Future analyses will present data for longer follow up and larger sample size. PCN126 Relative Value Assessment: Characterizing the Benefit of Oncology Therapies Through Diverse Metrics Macaulay R1, Farrimond B1, Ahuja A2, Ademisoye E1, Shaw J3, Orsini L3 Consulting, London, UK, 2PAREXEL Access Consulting, Chandigarh, India, 3Bristol-Myers Squibb, Princeton, NJ, USA
1PAREXEL Access
Objectives: The unmet need for oncology therapies is substantial. The introduction of innovative, high-cost treatments, coupled with mounting budgetary pressures, will necessitate value trade-offs across cancer types. Defining value will be critical to informing decision-making. Relative value assessment was conducted using a diverse set of outcome metrics and treatment costs for a variety of metastatic cancers. Methods: A review of sources published between 1/1/2000-11/30/2015 identified outcomes data for approved treatments for metastatic cancers. Data were extracted or derived for median and mean OS, milestone survival rates, and other outcomes metrics. Relative outcomes were compared across treatments with and without consideration of costs. In cost-outcome analyses, the cost per given survival benefit identified agents with the highest relative value. Results: Survival metric results varied by agent within cancer type. For instance, when used for treating NSCLC, nivolumab yielded the highest improvement in mean OS (4.1 months, pretreated squamous disease) and 1-year survival rate (10.8 percentage points, pretreated non-squamous disease), whereas afatinib yielded the highest median OS improvement (4.1 months, 1st-line EGFR Del19 and L858R mutants). For treatment of prostate cancer, abiraterone yielded the highest improvement in 1-year survival rate (14.4 percentage points, pre-treated), while enzalutamide yielded the highest median OS improvement (4.8 months, pre-treated) and sipuleucel-T the highest mean OS improvement (3.6 months, 1st-line). Results of cost-value analyses varied with the applied metric as some agents achieved a higher cost-value with some metrics but not with others. Conclusions: Valuing oncology therapies based on improvements in median OS yields distinct results versus other survival metrics. Unlike other metrics, median OS fails to account for long-term survival benefits. Other frameworks developed for assessing the value of oncology therapies (e.g., ASCO, ESMO) are driven by median OS/PFS benefits and may not adequately value long-term survival, which is the ultimate goal of cancer treatment.
CANCER – Patient-Reported Outcomes & Patient Preference Studies PCN127 Economic Burden due to Treatment Non-Adherence in Patients with Breast Cancer: A Systematic Review Gupta J1, Joshi P2, Kamra S2, Sehgal M2 International, New Delhi, India, 2PAREXEL International, Chandigarh, India
1PAREXEL
Objectives: Adherence to oral medications among patients with breast cancer (BC) has been reported to be suboptimal. We conducted a systematic literature review to assess the economic burden due to treatment non-adherence among patients with BC. Methods: Embase® and MEDLINE® were searched for the relevant studies published post 2005. Each citation was reviewed by two independent reviewers; any disagreement was resolved by a third reviewer. Results: Of the 595 citations obtained from the database search, three studies met the inclusion criteria. Adherence to hormone therapy (two studies) was measured by proportion of days covered and to lapatinib (one study) by medication possession ratio, time to treatment interruption/discontinuation and time to end of continuous treatment. The proportion of non-adherent patients ranged from 22% to 46% across the included studies. In an economic evaluation, low adherence to tamoxifen was found to be associated with an increased discounted medical cost of £5,970 (95%CI: £4,644–£7,372) over an average patient’s lifetime. This study used data for women with incident BC between 1993 and 2000 in the Tayside region of Scotland. Key contributors to increased cost were in-patient stay and other dispensing costs. Similarly, among patients with non-metastatic BC, medical costs in the adherent group with tamoxifen and aromatase inhibitors appeared to be lower than in the non-adherent group during the 4-year study period (difference between non-adherent and adherent: $1,476 [year 1], $8,008 [year 2], $-290 [year 3], and $1,857 [year 4]). Adjusted medical costs were reported to be 31% less for adherent cohort. Among women with metastatic BC, a statistically non-significant association was reported between non-adherence to lapatinib and total healthcare costs (p= 0.870). Conclusions: Limited published evidence suggested that treatment non-adherence tends to increase medical and overall healthcare costs in BC. Improvement in adherence can help in reducing the economic burden in long-term and improve cost-effectiveness. PCN128 A Systematic Review to Assess the Impact of Non-Adherence to Treatments on Health Care Cost in Chronic Myeloid Leukemia Gupta J1, Kamra S2, Joshi P2, Sehgal M2 International, New Delhi, India, 2PAREXEL International, Chandigarh, India
1PAREXEL
Objectives: To assess the cost implications of non-adherence to treatment among the patients with chronic myeloid leukemia (CML). Methods: Relevant English-language studies were searched from Embase® and MEDLINE®. Two independent reviewers reviewed each study and any disagreement was resolved by third reviewer. Results: Six out of 216 studies were included. All studies were retrospective in design and utilized medication possession ratio (MPR) to measure adherence except one, which utilized proportion of days covered. Treatments assessed included imatinib in four studies and dasatinib, imatinib, and nilotinib in two studies. Percentage of non-adherent patients ranged from 14% with dasatinib to 66% with imatinib. Across the studies, higher adherence was associated with lower total healthcare cost including medical, inpatient, and outpatient cost. In the