Ben Y. Durkee

Cost-Effectiveness of Pertuzumab in Human Epidermal Growth Factor Receptor 2–Positive Metastatic Breast Cancer

PURPOSE The Clinical Evaluation of Pertuzumab and Trastuzumab (CLEOPATRA) study showed a 15.7-month survival benefit with the addition of pertuzumab to docetaxel and trastuzumab (THP) as first-line treatment for patients with human epidermal growth factor receptor 2 (HER2) -overexpressing metastatic breast cancer. We performed a cost-effectiveness analysis to assess the value of adding pertuzumab. PATIENT AND METHODS We developed a decision-analytic Markov model to evaluate the cost effectiveness of docetaxel plus trastuzumab (TH) with or without pertuzumab in US patients with metastatic breast cancer. The model followed patients weekly over their remaining lifetimes. Health states included stable disease, progressing disease, hospice, and death. Transition probabilities were based on the CLEOPATRA study. Costs reflected the 2014 Medicare rates. Health state utilities were the same as those used in other recent cost-effectiveness studies of trastuzumab and pertuzumab. Outcomes included health benefits expressed as discounted quality-adjusted life-years (QALYs), costs in US dollars, and cost effectiveness expressed as an incremental cost-effectiveness ratio. One- and multiway deterministic and probabilistic sensitivity analyses explored the effects of specific assumptions. RESULTS Modeled median survival was 39.4 months for TH and 56.9 months for THP. The addition of pertuzumab resulted in an additional 1.81 life-years gained, or 0.62 QALYs, at a cost of

Cost-effectiveness of Stereotactic Body Radiation Therapy versus Radiofrequency Ablation for Hepatocellular Carcinoma: A Markov Modeling Study.

472,668 per QALY gained. Deterministic sensitivity analysis showed that THP is unlikely to be cost effective even under the most favorable assumptions, and probabilistic sensitivity analysis predicted 0% chance of cost effectiveness at a willingness to pay of

The Case for Prostate Brachytherapy in the Affordable Care Act Era

100,000 per QALY gained. CONCLUSION THP in patients with metastatic HER2-positive breast cancer is unlikely to be cost effective in the United States.

Semi-automatic segmentation of subcutaneous tumours from micro-computed tomography images

Purpose To assess the cost-effectiveness of stereotactic body radiation therapy (SBRT) versus radiofrequency ablation (RFA) for patients with inoperable localized hepatocellular carcinoma (HCC) who are eligible for both SBRT and RFA. Materials and Methods A decision-analytic Markov model was developed for patients with inoperable, localized HCC who were eligible for both RFA and SBRT to evaluate the cost-effectiveness of the following treatment strategies: (a) SBRT as initial treatment followed by SBRT for local progression (SBRT-SBRT), (b) RFA followed by RFA for local progression (RFA-RFA), (c) SBRT followed by RFA for local progression (SBRT-RFA), and (d) RFA followed by SBRT for local progression (RFA-SBRT). Probabilities of disease progression, treatment characteristics, and mortality were derived from published studies. Outcomes included health benefits expressed as discounted quality-adjusted life years (QALYs), costs in U.S. dollars, and cost-effectiveness expressed as an incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analysis was performed to assess the robustness of the findings. Results In the base case, SBRT-SBRT yielded the most QALYs (1.565) and cost

TU-AB-BRA-10: Prognostic Value of Intra-Radiation Treatment FDG-PET and CT Imaging Features in Locally Advanced Head and Neck Cancer

197 557. RFA-SBRT yielded 1.558 QALYs and cost

Cost-effectiveness of radiation and chemotherapy for high-risk low-grade glioma

193 288. SBRT-SBRT was not cost-effective, at

Reply to R. Colomer et al

558 679 per QALY gained relative to RFA-SBRT. RFA-SBRT was the preferred strategy, because RFA-RFA and SBRT-RFA were less effective and more costly. In all evaluated scenarios, SBRT was preferred as salvage therapy for local progression after RFA. Probabilistic sensitivity analysis showed that at a willingness-to-pay threshold of

Hypofractionated Intensity-Modulated Radiotherapy for Patients With Non–Small-Cell Lung Cancer

100 000 per QALY gained, RFA-SBRT was preferred in 65.8% of simulations. Conclusion SBRT for initial treatment of localized, inoperable HCC is not cost-effective. However, SBRT is the preferred salvage therapy for local progression after RFA.

Fractionation of palliative radiotherapy in metastatic breast cancer: Selection and survival.

Few oncologic entities are more deserving of national scrutiny than low-risk prostate cancer. Prostate cancer is among the top 5 most costly cancers, with

Sinoatrial node toxicity after stereotactic ablative radiation therapy to lung tumors

11.9 billion spent annually in the United States (1). Recent publications have drawn attention to financially driven practices and questionable referral patterns (2, 3). The Congressional Budget Office estimates that half the increase in health care expenditures over the past decades has been driven by expanded capabilities associated with new technologies (4). Intensity modulated radiation therapy (IMRT) and proton therapy come to mind. IMRT now accounts for more than 80% of radiation therapy treatments (5). Brachytherapy, by contrast, has been steadily declining in the United States (6). Payors are taking notice. Blue Shield of California and Aetna have stopped covering proton therapy for prostate cancer. Government and privately administered health insurers cut costs by reimbursing IMRT at a fraction of the billable rate. Treating institutions respond by inflating rates to compensate for aggressive cuts.