J. Félix

EPICE-HIV: An Epidemiologic Cost-Effectiveness Model for HIV Treatment

The goal of this research was to establish a new and innovative framework for cost-effectiveness modeling of HIV-1 treatment, simultaneously considering both clinical and epidemiological outcomes. EPICE-HIV is a multi-paradigm model based on a within-host micro-simulation model for the disease progression of HIV-1 infected individuals and an agent-based sexual contact network (SCN) model for the transmission of HIV-1 infection. It includes HIV-1 viral dynamics, CD4+ T cell infection rates, and pharmacokinetics/pharmacodynamics modeling. Disease progression of HIV-1 infected individuals is driven by the interdependent changes in CD4+ T cell count, changes in plasma HIV-1 RNA, accumulation of resistance mutations and adherence to treatment. The two parts of the model are joined through a per-sexual-act and viral load dependent probability of disease transmission in HIV-discordant couples. Internal validity of the disease progression part of the model is assessed and external validity is demonstrated in comparison to the outcomes observed in the STaR randomized controlled clinical trial. We found that overall adherence to treatment and the resulting pattern of treatment interruptions are key drivers of HIV-1 treatment outcomes. Our model, though largely independent of efficacy data from RCT, was accurate in producing 96-week outcomes, qualitatively and quantitatively comparable to the ones observed in the STaR trial. We demonstrate that multi-paradigm micro-simulation modeling is a promising tool to generate evidence about optimal policy strategies in HIV-1 treatment, including treatment efficacy, HIV-1 transmission, and cost-effectiveness analysis.

Therapeutic and Economic Value of Everolimus Plus Exemestane for the Treatment of Postmenopausal Women with Hormone Receptor-Positive, Her2/Neu Negative Advanced Breast Cancer.

Cost-effectiveness of everolimus+exemestane as compared to fulvestrant was assessed in terms of the incremental cost per life year (LY) gained, from a Portuguese National Health Service (NHS) perspective. Next to main therapeutic drug costs, other healthcare costs included costs for medical visits, complementary diagnostic procedures, surgery, inpatient visits, additional therapy and end-of-life care. An annual 5% discount rate was applied to both costs and effectiveness.

Cost-Effectiveness of Lenalidomide-Plus-Dexamethasone in Multiple Myeloma Patients Who Have Received at Least One Prior Therapy: A South Korean Perspective.

treatments with respect to PFS were estimated through a survival analysis of patient-level data (Celgene data on file). Due to the potential of crossover/subsequent treatment options induced bias, OS was estimated using a quantitative relationship between PFS and OS from a censored normal weighted Tobit regression model, based on 153 MM studies containing 230 treatment arms7. In this study, Félix et all (2013) estimated that a 2.5 month (95% confidence interval, 1.7–3.2) increment in median OS is expected for each additional month in median PFS (Table 1). COST-EFFECTIVENESS OF LENALIDOMIDE-PLUSDEXAMETHASONE IN MULTIPLE MYELOMA PATIENTS WHO HAVE RECEIVED AT LEAST ONE PRIOR THERAPY: A SOUTH KOREAN PERSPECTIVE Vandewalle B1, Félix J1, Almeida JM1, Valeska A1 , Yeo R2

Upfront Overall Survival Modelling in Comparison to Real World Data: Lenalidomide for the Treatment of Multiple Myeloma Patients in South Korea.

Decision makers are frequently faced with the question of how realistic are cost-effectiveness models. Overall survival (OS) is a desired clinical trial and health technology assessment endpoint but frequently unrealistic or elusive at the point of new drugs financing decision. We aim to compare the overall survival from lenalidomide treatment in relapsed/refractory multiple myeloma (rrMM) patients estimated from modelling clinical trial data in a costeffectiveness analysis (CEA) and compare it with real-word data (RWD) from South Korea.