Kelly Lien
Sunnybrook Health Sciences Centre
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Biomarkers in Medicine | 2014
Gemma Cramarossa; Esther K. Lee; Lavarnan Sivanathan; Soley Georgsdottir; Kelly Lien; Keemo Delos Santos; Kelvin K. Chan; Urban Emmenegger
Low-dose metronomic (LDM) chemotherapy is a beneficial and very well-tolerated form of chemotherapy utilization characterized by the frequent and uninterrupted administration of low doses of conventional chemotherapeutic agents over prolonged periods of time. While patients resistant to standard maximum tolerated dose (MTD) chemotherapy may still benefit from LDM chemotherapy, there is a lack of predictive markers of response to LDM chemotherapy. We searched the MEDLINE, EMBASE, CENTRAL and PubMed databases for correlative studies conducted as part of LDM chemotherapy trials in order to identify the most promising biomarker candidates. Given the antiangiogenic properties of LDM chemotherapy, angiogenesis-related biomarkers were most commonly studied. However, significant correlations between angiogenesis-related biomarkers and study end points were rare and variable, even so far as biomarkers correlating positively with an end point in some studies and negatively with the same end point in other studies. Pursuing biomarkers outside the angiogenesis field may be more promising.
Current Oncology | 2015
Kelly Lien; V.C. Tam; Yoo-Joung Ko; Nicole Mittmann; Matthew C. Cheung; Kelvin K. Chan
BACKGROUND Previous Canadian cost-effectiveness analyses in cancer based on the EQ-5D-3L (EuroQoL, Rotterdam, Netherlands) have commonly used U.K. or U.S. tariffs because the Canadian equivalent only just recently became available. The implications of using non-Canadian tariffs to inform decision-making are unclear. We aimed to reevaluate an earlier cost-effectiveness analysis of therapies for metastatic pancreatic cancer (originally performed using U.S. tariffs) with tariffs from Canada and various other countries to determine the impact of using non-country-specific tariffs. METHODS We used tariffs from Canada, the United States, the United Kingdom, Denmark, France, Germany, Japan, the Netherlands, and Spain to derive EQ-5D-3L utilities for the 10 health states in the pancreatic cancer model. Quality-adjusted life years (qalys) and incremental cost-effectiveness ratios (icers) were generated, and probabilistic sensitivity analyses (psas) were performed. RESULTS Canadian utilities are generally lower than the corresponding U.S. utilities and higher than those for the United Kingdom. Compared with the Canadian-valued scenarios, U.S. and U.K. estimates were statistically different for 3 and 9 scenarios respectively. Overall, 35% of the non-Canadian utilities (28 of 80) were significantly different, clinically, from the Canadian values. Canadian qalys were 6% lower than those for the United States and 6% higher than those for the United Kingdom. When comparing the qalys of each treatment with those of gemcitabine alone, the average percent change was +6.8% for a U.S. scenario and -7.5% for a U.K. scenario compared with a Canadian scenario. Consequently, Canadian icers were approximately 5.4% greater than those for the United States and 8.6% lower than those for the United Kingdom. Based on the psas and compared with the Canadian threshold value, the minimum willingness-to-pay threshold at which the combination chemotherapy regimen of gemcitabine-capecitabine is the most cost-effective is
Value in Health | 2017
Doug Coyle; Yoo-Joung Ko; Kathryn Coyle; Ronak Saluja; Keya Shah; Kelly Lien; Henry Lam; Kelvin K. Chan
5,239 less than in the United States and
Journal of Oncology Practice | 2016
Maria Carmen Riesco-Martínez; Scott R. Berry; Yoo-Joung Ko; Nicole Mittmann; Angie Giotis; Kelly Lien; William W. L. Wong; Kelvin K. Chan
11,986 more than in the United Kingdom. CONCLUSIONS The use of non-country-specific tariffs leads to significant differences in the derived utilities, icers, and psa results. Past Canadian EQ-5D-3L-based cost-effectiveness analyses and related funding decisions might need to be re-visited using Canadian tariffs.
Oral Oncology | 2017
Katarzyna J. Jerzak; Keemo Delos Santos; Ronak Saluja; Kelly Lien; Justin Lee; Kelvin K. Chan
OBJECTIVES To assess the cost-effectiveness of gemcitabine (G), G + 5-fluorouracil, G + capecitabine, G + cisplatin, G + oxaliplatin, G + erlotinib, G + nab-paclitaxel (GnP), and FOLFIRINOX in the treatment of advanced pancreatic cancer from a Canadian public health payers perspective, using data from a recently published Bayesian network meta-analysis. METHODS Analysis was conducted through a three-state Markov model and used data on the progression of disease with treatment from the gemcitabine arms of randomized controlled trials combined with estimates from the network meta-analysis for the newer regimens. Estimates of health care costs were obtained from local providers, and utilities were derived from the literature. The model estimates the effect of treatment regimens on costs and quality-adjusted life-years (QALYs) discounted at 5% per annum. RESULTS At a willingness-to-pay (WTP) threshold of greater than
CMAJ Open | 2016
Nicolas J. Chin-Yee; Andrew T. Yan; Alexander Kumachev; Dennis T. Ko; Craig C. Earle; George Tomlinson; Maureen E. Trudeau; Murray Krahn; Monika Krzyzanowska; Raveen Pal; Christine Brezden-Masley; Scott Gavura; Kelly Lien; Kelvin K. Chan
30,666 per QALY, FOLFIRINOX would be the most optimal regimen. For a WTP threshold of
Expert Review of Pharmacoeconomics & Outcomes Research | 2015
Kelly Lien; Scott R. Berry; Yoo-Joung Ko; Kelvin K. Chan
50,000 per QALY, the probability that FOLFIRINOX would be optimal was 57.8%. There was no price reduction for nab-paclitaxel when GnP was optimal. CONCLUSIONS From a Canadian public health payers perspective at the present time and drug prices, FOLFIRINOX is the optimal regimen on the basis of the cost-effectiveness criterion. GnP is not cost-effective regardless of the WTP threshold.
Archive | 2014
Keemo Delos Santos; Lavarnan Sivanathan; Kelly Lien; Urban Emmenegger
PURPOSE Patients with unresectable wild-type KRAS metastatic colorectal cancer benefit from fluoropyrimidines (FP), oxaliplatin (O), irinotecan (I), bevacizumab (Bev), and epithelial growth factor receptor inhibitors (EGFRI). The most cost-effective regimen remains unclear. METHODS A Markov model was constructed to examine the costs and outcomes of three treatment strategies: strategy A (reference strategy): EGFRI monotherapy in third line ([3L]; ie, first-line [1L]: Bev + FOLFIRI [FP + I] or FOLFOX [FP + O]; second line [2L]: FOLFIRI/FOLFOX; 3L: EGFRI); strategy B: EGFRI and I in 3L (ie, 1L: Bev + FOLFIRI/FOLFOX; 2L: FOLFIRI/FOLFOX; 3L: EGFRI + I); and strategy C: EGFRI in 1L (ie, 1L: EGFRI + FOLFIRI/FOLFOX; 2L: Bev + FOLFIRI/FOLFOX; 3L: best supportive care). Efficacy data of the treatments were obtained from the literature. Health system resource use information was derived from chart review and the literature. Using Euro-QOL 5 Dimensions, utilities were obtained by surveying medical oncologists and costs from the Ontario Ministry of Health and the literature. The perspective of the Canadian public health care system was used over a 5-year time horizon with a 5% discount in 2012 Canadian dollars. RESULTS All three strategies had similar efficacy, but strategy C was most expensive. The incremental cost-effectiveness ratios (ICERs) for strategies B and C compared with A were 119,623 and 3,176,591, respectively. The model was primarily driven by the acquisition cost of the drugs. Strategy B was most cost effective when the willingness-to-pay threshold was >
Journal of Clinical Oncology | 2013
Alexander Kumachev; Nicolas J. Chin-Yee; Andrew T. Yan; George Tomlinson; Craig C. Earle; Maureen E. Trudeau; Dennis T. Ko; Monika K. Krzyzanowska; Raveen Pal; Christine B. Brezden; Scott Gavura; Kelly Lien; Kelvin K. Chan
130,000 per quality-adjusted life-year. Sensitivity analysis showed that strategy C would be cost-effective only when the progression-free survival of EGFRI is better than Bev in 1L with hazard ratio < 0.23 at willingness-to-pay of
International Journal of Cancer | 2018
Kelvin K. Chan; Ronak Saluja; Keemo Delos Santos; Kelly Lien; Keya Shah; Gemma Cramarossa; Xiaofu Zhu; Rebecca Wong
150,000 per quality-adjusted life-year. CONCLUSION First-line use of EGFRI in metastatic colorectal cancer is not cost effective at its current pricing relative to Bev.