Lionel Perrier

Economic Impact of Centralized Histological Reviews in Patients with Sarcoma, Gist, and Desmoid Tumors

Lionel Perrier, PhD1,2; Samuel Kembou Nzale, MSc1; Pauline Rascle, MSc1; Binh Bui Nguyen, MD3; Magali Morelle, MSc1,2; Dominique Ranchère Vince, MD4; Philippe Terrier, MD5; Agnès Neuville, MD6; Anne-Valérie Decouvelaere, MD4; Axel Le Cesne, MD7; Frédéric Gomez, MD8; Christelle de la Fouchardière, MD9; Pierre Meeus, MD10; Olivier Tredan, MD9; Maurice Pérol, MD9; Jérôme Fayette, MD9; Eve-Marie Neidhardt, MD9; Pierre Biron, MD9; Helen Boyle, MD9; Perrine Marec-Bérard MD11, Fadila Farsi MD12; Françoise Ducimetière, PhD13; Jean-Yves Blay, MD, PhD9; Isabelle Ray-Coquard, MD, PhD9,13Jean-Michel Coindre, MD, PhD6

A Cost-Analysis of Complex Radiotherapy in Patients with Head and Neck Cancer Results from the Art-Orl Study

1 Gate-UMR 58234, University of Lyon, Lyon, France, 2 Leon Berard Cancer Centre, Lyon, France, 3 Institut Régional de Cancérologie de Montpellier, Montpellier, France, 4 Centre Oscar Lambret, Lille, France, 5 Clinique Pasteur, Toulouse, France, 6 Institut Sainte Catherine, Avignon, France, 7 Centre René Gauducheau, Saint Herblain, France, 8 Institut Claudius Regaud, Toulouse, France, 9 Institut Curie, Paris, France, 10 Centre Eugène Marquis, Rennes, France, 11 Centre Paul Strauss, Strasbourg, France, 12 Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy,France, 13 Hôpital Européen Georges Pompidou, Paris, France

CA1 Discordant Diagnoses in Sarcoma, GIST and Desmoide Tumour in France: Results From the Network RREPS

CA1 DISCORDANT DIAGNOSES IN SARCOMA, GIST AND DESMOIDE TUMOUR IN FRANCE: RESULTS FROM THE NETWORK RREPS Perrier L1, Ranchr̀e Vince D1, Terrier P2, Neuville A3, Decouvelaere AV1, Bui B3, Le Cesne A2, Ray Coquard I1, Ducimetière F1, Jean-Denis M1, Courrèges JB3, Mesli N2, Morelle M1, Plommet N4, Blay JY1, Coindre JM3 1Leon Berard Cancer Centre, Lyon, France, 2Insitut Gustave Roussy, Villejuif, France, 3Institut Bergonié, Bordeaux, France, 4University Lyon 2, Lyon, France OBJECTIVES: Major discordant diagnoses may have strong impact on therapeutic management. So, identification of major discordant diagnoses and predictive factors were conducted in sarcoma patients. METHODS: A multicenter analysis was performed retrospectively from the prospective cohort of sarcoma patients. Inclusion criteria were patients with a diagnosis of sarcoma in 2010 and with a second opinion performed within the network RRePS (Réseau de Référence en Pathologie des Sarcomes supported be the French NCI). Major discordant diagnoses were defined as: sarcoma vs benign lesion, sarcoma vs malignant non sarcoma tumor, gastrointestinal stromal tumors (GIST) vs non GIST, and desmoid tumor vs non desmoid tumor. Patient and disease characteristics were described. Logistic regressions were used in order to define predictive factors of major discordance. RESULTS: 3621 patients were included in the study. 438 patients (12%) had a major discordant diagnoses: sarcoma versus benign lesion (or conversely) in 155 patients (58%); sarcoma instead of malignant non sarcoma tumor (or conversely) in 103 patients (24%); gastrointestinal stromal tumors (GIST) instead of non GIST in 48 patients (11%); desmoid tumor instead of non desmoid tumor in 28 patients (6%) and other (4%). Major diagnostic discordances risks were higher (i) for malignant non sarcoma tumors compared to GIST, liposarcoma, and other sarcoma histological subtypes (p 0.004); (ii) for patients who had a previous cancer (p 0.03); (iii) for limb localization compared to trunk (p 0.004); (iv) when the second opinion was requested by the initial pathologist (p 0.01). CONCLUSIONS: This study reported that sarcoma instead of benign lesion (or conversely) is the major discordant diagnosis in sarcoma patients implying that: (i) patients who should not be treated received anticancer therapy; (ii) treatments are potentially delayed for patients who should be rapidly treated. Economics evaluations are in progress in order to advise health care administrators regarding systematic second reviews in the management of sarcoma.

MC1 ASSESSING THE GENERALISABILITY OF COST EVALUATION RESULTS USING THE EUCLIDEAN METRIC AND PRINCIPAL COMPONENTS ANALYSIS: LESSON FROM A HIGH-COST INNOVATION IN ONCOLOGY

cohort characteristics (mean age 63.1 years, diabetes duration 12.8 years, HbA1c 8.17%, BMI 30.3 kg/m) were based on the German cohort of the PREDICTIVE (Predictable Results and Experience in Diabetes through Intensification and Control to Target: an International Variability Evaluation) study. Direct medical costs were derived from published sources and expressed in 2006 Euro (€) values. Projections were made over a 35-year time horizon. Future costs and clinical benefits were discounted at 3.5% annually. Sensitivity analyses were performed. RESULTS: Treatment with IAsp was projected to improve quality-adjusted life expectancy by approximately 0.10 qualityadjusted life years (QALYs) (6.06 0.09 versus 5.96 0.09 QALYs). Increased treatment costs with IAsp were partially offset by cost savings due to reductions in the cumulative incidence of diabetes-related complications. Over patient lifetimes, mean direct medical costs were projected to increase by approximately €1,274 per patient with IAsp versus HSI (€45,423 1,354 versus €44,149 1,391). This resulted in an incremental cost-utility ratio of €13,305 per QALY gained. CONCLUSION: Over patient lifetimes, IAsp treatment was projected to result in fewer diabetes-related complications and improved quality-adjusted life expectancy compared to HSI. Based on currently accepted willingness-to-pay limits, IAsp would represent good value for money in the German setting.