C Fang

When is Cancer Care Cost-Effective? A Systematic Overview of Cost–Utility Analyses in Oncology

New cancer treatments pose a substantial financial burden on health-care systems, insurers, patients, and society. Cost-utility analyses (CUAs) of cancer-related interventions have received increased attention in the medical literature and are being used to inform reimbursement decisions in many health-care systems. We identified and reviewed 242 cancer-related CUAs published through 2007 and included in the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org). Leading cancer types studied were breast (36% of studies), colorectal (12%), and hematologic cancers (10%). Studies have examined interventions for tertiary prevention (73% of studies), secondary prevention (19%), and primary prevention (8%). We present league tables by disease categories that consist of a description of the intervention, its comparator, the target population, and the incremental cost-effectiveness ratio. The median reported incremental cost-effectiveness ratios (in 2008 US

30 years of pharmaceutical cost-utility analyses: growth, diversity and methodological improvement.

) were

Cost-utility analyses of diagnostic laboratory tests: a systematic review.

27,000 for breast cancer,

Does framing of cancer survival affect perceived value of care? A willingness-to-pay survey of US residents

22,000 for colorectal cancer,

PMC5 AN ANATOMY OF PHARMACEUTICAL COST-UTILITY ANALYSES, 1976–2005

34,500 for prostate cancer,

Cancer Therapy Costs Influence Treatment: A National Survey Of Oncologists

32,000 for lung cancer, and

Willingness‐to‐pay for predictive tests with no immediate treatment implications: a survey of US residents

48,000 for hematologic cancers. The results highlight the many opportunities for efficient investment in cancer care across different cancer types and interventions and the many investments that are inefficient. Because we found only modest improvement in the quality of studies, we suggest that journals provide specific guidance for reporting CUA and assure that authors adhere to guidelines for conducting and reporting economic evaluations.

PHP103 WHEN ARE DIAGNOSTIC LABORATORY TESTS COST-EFFECTIVE? A SYSTEMATIC REVIEW OF COST-UTILITY ANALYSES

AbstractObjective: To review and critically evaluate published cost-utility analyses (CUAs) pertaining to pharmaceuticals for the past 3 decades. Methods: We examined data from the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org), which contains detailed information on English-language CUAs and their ratios (in

PCN95 STRUGGLING WITH EXPENSIVE NEW CANCER THERAPIES: A NATIONAL SURVEY OF ONCOLOGISTS IN THE UNITED STATES

US, year 2008 values) published in peer-reviewed journals. We summarized study features using descriptive statistics for articles published from 1976 to 2006. Changes in study methodology over time were analysed by trend test. Analysis of ratios was restricted to those published from 2000 to 2006 from studies that correctly discounted future costs and benefits. Factors associated with having a favourable value (defined to be more than the median for all included ratios) were identified by logistic regression. Results: Of 1393 CUAs published through 2006, 640 (45.9%) pertained to pharmaceuticals. The proportion of CUAs that focussed on pharmaceuticals increased from 34% for the period 1990–5 to 47% for the period 2001–5. Investigations with a US perspective accounted for 51% of all CUAs, although this proportion has decreased over time. The UK perspective investigations accounted for nearly 16% of all studies, and this portion has increased over time. About 24% of all CUAs were sponsored by industry, 48% were sponsored by non-industry sources, and 28% did not disclose their funding. Adherence to good methodological practices is roughly similar for studies with industry and non-industry sponsorship. Adherence to these practices has increased over time. Among the 1969 ratios meeting our inclusion criteria, the median value was

CN1 HOW MUCH DOES ADJUSTING FOR HEALTH-RELATED QUALITY OF LIFE MATTER IN COST-EFFECTIVENESS ANALYSIS? A COMPARISON OF COST/LIFE YEAR AND COST/QALY ESTIMATES FOR CANCER INTERVENTIONS

US22 000 per QALY.Logistic regression revealed that, while controlling for the intervention category (e.g. pharmaceutical, medical device, screening), ratios were more likely to be favourable if they were from studies sponsored by a pharmaceutical or device manufacturer (OR 1.53; 95% CI 1.07, 2.19). Ratios for pharmaceutical CUAs were less favourable than other ratios while controlling for sponsorship (OR 0.66; 95% CI 0.44, 0.98). Conclusion: The number of published pharmaceutical CUAs has grown steadily and accounts for almost half of all published CUAs. Adherence to good methodological practices does not appear to differ by study sponsor. Ratios from industry-sponsored studies are more favourable than other ratios. The results highlight that there are many opportunities for efficient healthcare investment, among pharmaceutical and non-pharmaceutical interventions, just as there are many investments that are inefficient.