K.L. Kuo

The Pharmacoeconomics of Breakthrough Cancer Pain

ABSTRACT Breakthrough cancer pain (BTP) has a significant impact on patients’ activities of daily living, family, and the society; however, the economic ramifications of BTP are largely unknown. This review aims to summarize the available pharmacoeconomics studies of BTP in the context of the availability of several formulations of rapid-onset opioids administered by various routes, which are significantly more expensive than oral opioids. A systematic literature search of PubMed and Tufts registry through August 2012 was conducted using key words including “breakthrough cancer pain” and “cost effectiveness.” After exclusion of irrelevant articles, a total of six articles were included. Studies reviewed include two economic survey studies, two quality improvement projects, and two decision-analytic models. These studies demonstrate BTP causes significant financial burden to patients and society through increased hospitalization and health care utilization. Only one study comparing placebo with intranasal fentanyl spray, oral transmucosal fentanyl citrate, and oral transmucosal fentanyl buccal tablet has demonstrated the cost-effectiveness of these rapid-onset opioids for the treatment of BTP. Overall, there is a lack of pharmacoeconomic studies for BTP management with rapid-onset opioids. Further study is warranted assessing the net benefit of rapid-onset opioids to oral opioids to assist decision-making by patients, clinicians, and payers.

Real-World Evidence in Pain Research: A Review of Data Sources

ABSTRACT Outcomes research studies use clinical and administrative data generated in the course of patient care or from patient surveys to examine the effectiveness of treatments. Health care providers need to understand the limitations and strengths of the real-world data sources used in outcomes studies to meaningfully use the results. This paper describes five types of databases commonly used in the United States for outcomes research studies, discusses their strengths and limitations, and provides examples of each within the context of pain treatment. The databases specifically discussed are generated from (1) electronic medical records, which are created from patient-provider interactions; (2) administrative claims, which are generated from providers’ and patients’ transactions with payers; (3) integrated health systems, which are generated by systems that provide both clinical care and insurance benefits and typically represent a combination of electronic medical record and claims data; (4) national surveys, which provide patient-reported responses about their health and behaviors; and (5) patient registries, which are developed to track patients with a given disease or exposure over time for specified purposes, such as population management, safety monitoring, or research.

Single- Versus Multiple-Drug Pharmacotherapy in the Management of Diabetic Painful Neuropathy

ABSTRACT This study compared patient characteristics and health care costs between newly treated diabetic painful neuropathy (DPN) patients receiving mono- pharmacotherapy and those receiving combination pharmacotherapy. A retrospective cohort was developed through Inovalons Medical Outcomes Research for Effectiveness and Economics Registry (MORE2) database. Patients included were ≥18 years on the date of first DPN prescription: tricyclic antidepressant, opioids, duloxetine, gabapentin, pregabalin, or lidocaine. The authors conducted a simple proportional hazards model comparing times to discontinuation, switch, or addon. Multiple logistic regression was used to identify predictors of combination pharmacotherapy. There were 7145 patients on mono-pharmacotherapy and 421 patients on combination pharmacotherapy. Patients receiving combination pharmacotherapy were 130% more likely to discontinue their medications than patients receiving mono-pharmacotherapy. Female patients and those with > 7 comorbidities were more likely to be started with combination pharmacotherapy. Elderly patients were less likely to be started with combination pharmacotherapy. The total cost of care difference between mono- and combination pharmacotherapy was not statistically significant (P = .66); therefore, newly treated DPN patients should add on another medication sooner than 30 days when considering combination pharmacotherapy. All first-line medications have similar efficacy; for this reason, cost should be considered in the treatment decision.

Decision Analysis on the Cost-Effectiveness of Sequential Treatment Strategies for Patients with Chronic Myeloid Leukemia in the United States

PCN144 DeCisioN ANAlysis oN the Cost-effeCtiveNess of sequeNtiAl treAtmeNt strAtegies for PAtieNts with ChroNiC myeloiD leukemiA iN the uNiteD stAtes Rochau U.1, Kluibenschaedl M.1, Stenehjem D.2, Kuo K.L.2, Oderda G.2, Brixner D.3, Siebert U.4 1UMIT University for Health Sciences, Medical Informatics and Technology/ ONCOTYROL Center for Personalized Cancer Medicine, Hall in Tyrol/ Innsbruck, Austria, 2University of Utah, Salt Lake City, UT, USA, 3UMIT University for Health Sciences, Medical Informatics and Technology/ ONCOTYROL Center for Personalized Cancer Medicine/ University of Utah, Hall in Tyrol/ Salt Lake City, UT, Austria, 4Medical Informatics and Technology, and Director of the Division for Health Technology Assessment and Bioinformatics, ONCOTYROL, Hall i. T, Austria Objectives: The first goal was to adapt an existing Austrian decision-analytic model for chronic myeloid leukemia (CML) treatment to the US-American health care context. Secondly, we updated the model with new data and further treatment strategies to identify the most effective and most cost-effective strategy for the treatment of CML patients with different sequential tyrosine kinase inhibitors (TKIs). MethOds: We evaluated 18 different treatment strategies within the US-American setting in terms of survival, quality-adjusted survival and costs. For model parameters, data from literature, a US-American expert survey, the Utah Cancer Registry, and economic data from a US-American database were used. Evaluated treatment strategies included imatinib, dasatinib, nilotinib, bosutinib, ponatinib, stem-cell transplantation and chemotherapy. The Markov state-transition model was analyzed as a cohort simulation over a lifelong time horizon, a third-party payer perspective was adopted and a discount rate of 3% was used. Additionally, several deterministic and probabilistic sensitivity analyses were conducted. Results: Imatinib without second-line TKI resulted in an incremental cost-utility ratio (ICUR) of

Response Monitoring, Tolerability, and Effectiveness of Imatinib Treatment for Chronic Myeloid Leukemia in a Retrospective Research Database

148,700/QALY gained (incremental cost-effectiveness ratio (ICER) of

Treatment Patterns and Outcomes in Patients With Hepatocellular Carcinoma Stratified by Stage-Guided Treatment Categories

128,800/Lys) compared to baseline strategy ‘chemotherapy’. Imatinib with second-line nilotinib yielded an ICUR of

The United States Physican Survey to Populate a Decision-Analytic Model for the Treatment of Chronic Myeloid Leukemia

217,100/QALY gained (ICER

Characteristics of Combination Pharmacotherapy in Patients with Diabetic Painful Neuropathy (DPN)

242,200/ LY) compared to imatinib without second-line TKI. Imatinib followed by secondline bosutinib had an ICUR of

Quality of Life Outcomes of the United States Chronic Myeloid Leukemia (CML) Patients

331,300/QALY gained (ICER

Research poster presentations – session IIIDisease-specific studies: Cancer - clinical outcomes studiesPCN32 Treatment Patterns and Outcomes of Melanoma Patients in a Patient-Centered Retrospective Research Registry

265,100/LY) compared to imatinib followed by second-line nilotinib. Imatinib with second-line dasatinib produced an ICUR of