Bernardo Goulart

A Trial-Based Assessment of the Cost-Utility of Bevacizumab and Chemotherapy versus Chemotherapy Alone for Advanced Non-Small Cell Lung Cancer

OBJECTIVES Bevacizumab is approved for treatment of advanced non-small cell lung cancer (NSCLC) in combination with chemotherapy based on a 2-month median survival benefit demonstrated in one randomized trial. The cost-utility of adding bevacizumab to chemotherapy in advanced NSCLC remains unknown. We evaluated the cost-utility of bevacizumab added to chemotherapy in patients with advanced NSCLC. METHODS We developed a Markov model to estimate quality-adjusted life years (QALYs) and direct medical costs from the US payer perspective in patients treated with bevacizumab plus chemotherapy and compared these outcomes with patients treated with chemotherapy alone. We populated the model with survival and toxicity data from the clinical trial that compared the two strategies. We obtained utilities from a literature search and unit costs from Medicare. We discounted QALYs and costs at 3% per year. We addressed uncertainty with one-way and probabilistic sensitivity analyzes. RESULTS Compared with chemotherapy alone, bevacizumab and chemotherapy increased mean QALYs by 0.13, at an incremental life-time cost of US

Moving beyond the national lung screening trial: discussing strategies for implementation of lung cancer screening programs.

72,000 per patient. The incremental cost-utility ratio (ICUR) was US

The Clinical and Economic Impacts of Skeletal-Related Events Among Medicare Enrollees With Prostate Cancer Metastatic to Bone

560,000/QALY. The ICUR was most sensitive to the survival on bevacizumab treatment, the drug costs of bevacizumab, and the utility of stable disease on treatment. At a threshold of US

Projected Clinical, Resource Use, and Fiscal Impacts of Implementing Low-Dose Computed Tomography Lung Cancer Screening in Medicare.

100,000/QALY, the addition of bevacizumab had a 0.2% probability of being cost-effective. CONCLUSIONS Bevacizumab does not appear to be cost-effective when added to chemotherapy in patients with advanced NSCLC, based on approximate cost-effectiveness thresholds that have been identified in the United States. These results may inform decision-makers about resource allocation for NSCLC care.

Value: The Next Frontier in Cancer Care

The National Lung Screening Trial (NLST) has sparked new interest in the adoption of lung cancer screening using low-dose computed tomography (LDCT). If adopted at a national level, LDCT screening may prevent approximately 18,000 lung cancer deaths per year, potentially constituting a high-value public health intervention. Before incorporating LDCT screening into practice, health care institutions need to consider the risks associated with LDCT screening and the impact of LDCT screening on health care costs, as well as other remaining areas of uncertainty, including the unknown cost-effectiveness of LDCT screening. This article will review the benefits and risks of LDCT screening in light of the results of the NLST and other randomized trials, it will discuss the additional health care costs associated with LDCT screening from the perspective of health care payers, and it will examine the published cost-effectiveness analyses of LDCT screening. A subsequent discussion highlights guideline recommendations for implementation strategies, the goals of which are to ensure that those eligible for LDCT screening derive the benefits while minimizing the risks of screening and avoiding an unnecessary escalation in screening-related costs. The article concludes by endorsing the use of LDCT screening in institutions capable of responsible implementation of screening in both medical and economic terms. The key elements of responsible implementation include the development of standardized screening practices, careful selection of screening candidates, and the creation of prospective registries that will mitigate current areas of uncertainty regarding LDCT screening.

A network meta-analysis of therapies for previously untreated chronic lymphocytic leukemia

BACKGROUND Approximately 40% of men diagnosed with metastatic prostate cancer experience one or more skeletal-related events (SREs), defined as a pathological fracture, spinal cord compression, or surgery or radiotherapy to the bone. Accurate assessment of their effect on survival, health care resource utilization (HCRU), and cost may elucidate the value of interventions to prevent SREs. MATERIALS AND METHODS Men older than age 65 years with prostate cancer and bone metastasis diagnosed between 2004 and 2009 were identified from linked Surveillance Epidemiology and End Results-Medicare records. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk for death associated with SREs were calculated by using Cox regression. HCRU and costs (in 2013 U.S. dollars) were evaluated in a propensity score-matched cohort by using Poisson regression and Kaplan-Meier sample average estimators, respectively. RESULTS Among 3,297 men with prostate cancer metastatic to bone, 40% experienced ≥1 SRE (median follow-up, 19 months). Compared with men who remained SRE-free, men with ≥1 SRE had a twofold higher risk for death (HR, 2.29; 95% CI, 2.09-2.51). Pathological fracture was associated with the highest risk for death (HR, 2.77; 95% CI, 2.38-3.23). Among men with ≥1 SRE, emergency department visits were twice as frequent (95% CI, 1.77-2.28) and hospitalizations were nearly four times as frequent (95% CI, 3.20-4.40). The attributable cost of ≥1 SRE was

Implementing Lung Cancer Screening Using Low-Dose Computed Tomography: Recommendations From an Expert Panel

21,191 (≥1 SRE:

The Value of Lung Cancer CT Screening: It Is All about Implementation.

72,454 [95% CI,

Predictors of outcome with cetuximab and paclitaxel for head and neck squamous cell carcinoma

67,362-

Concurrent cetuximab and postoperative radiation in resected high-risk squamous cell carcinomas of the head and neck: A single-institution experience.

76,958]; SRE-free: