Marjolein Pompen

Direct costs associated with the disease management of patients with unresectable advanced non-small-cell lung cancer in The Netherlands

INTRODUCTION Disease management and costs of treatment of patients with unresectable advanced non-small-cell lung cancer (NSCLC) in The Netherlands are not well known. METHODS A retrospective medical chart review was performed by collecting data from the time of diagnosis until the time of death or the end of the evaluation period. In addition to the demographic data, information was collected on the overall management of the patient. Hospital resource utilisation data collected included number of outpatient specialist visits, number and length of hospitalisation, type and number of diagnostic and laboratory procedures, type and number of radiotherapy cycles and detailed information on chemotherapy. To evaluate the economic impact of second-line treatment, a distinction was made between patients who received only best supportive care (BSC, group A) and those who received chemotherapy as a second-line treatment in addition to BSC (group B). The study was performed from the hospital perspective and reports on 2005 costs. RESULTS Of 102 patients, 74 belonged to group A and 28 to group B. Patient management included a multidisciplinary approach, the extent of which depended on symptoms of the disease and presence of metastases. The average total treatment cost per patient per year of unresectable advanced NSCLC in The Netherlands was euro32,840 in group A and euro31,187 in group B. In both groups, hospitalisation was the major cost driver. In group B second-line chemotherapy was the second largest contributor of the costs. In spite of the difference in numbers of treatment lines provided to patients in groups A and B the total average costs per patient per year were comparable. Overall, the management of unresectable advanced NSCLC appeared to conform with current guidelines in The Netherlands. CONCLUSION These patients show high medical resource consumption, with hospitalisation being the main cost driver in both groups. As economic arguments are becoming increasingly important in medical decision making on both national and local levels, this information is relevant for both policy makers and specialists. These data can also be used in future research to evaluate the economic impact of new therapies in NSCLC, especially of those that aim to treat patients in an outpatient setting.

Transferability of model-based economic evaluations: the case of trastuzumab for the adjuvant treatment of HER2-positive early breast cancer in the Netherlands.

INTRODUCTION Geographic transferability of model-based cost-effectiveness results may facilitate and shorten the reimbursement process of new pharmaceuticals. This study provides a real world example of transferring a cost-effectiveness study of trastuzumab for the adjuvant treatment of HER2-positive early breast cancer from the United Kingdom to The Netherlands. METHODS Three successive steps were taken. Step 1: Collect available information with regard to the original model, and assess transferability using existing checklists. Step 2: Adapt transferability-limiting factors. Step 3: Obtain a country-specific estimate of cost-effectiveness. RESULTS The structure of the UK model was transferable, although some of the model inputs needed adaptation. From a health-care perspective, the Dutch estimate amounted to euro5828/quality-adjusted life-year gained. From a societal perspective, the incremental cost-effectiveness ratio was dominant. CONCLUSION Transferability of a model-based UK-study in three steps proved to be an efficient method to provide an early indication of the cost-effectiveness of trastuzumab and has led to the provisional reimbursement of the treatment.

MD2 ECONOMIC CONSEQUENCES OF PROVIDING RITUXIMAB AS ATREATMENT ALTERNATIVE FOR RHEUMATOID ARTHRITIS IN THE NETHERLANDS

prescription drug benefit program for the elderly instituted at the end of 2005 in the United States. METHODS: We implemented retrospective analyses of pharmacy claims of beneficiaries aged 67–79 years from 2005 to 2006, from a large pharmacy chain in the United States. Subjects aged 61–63 were used a control group in a differences-in-differences approach to account for trends not related to Part D. The final sample represented approximately 2.4 million unique beneficiaries aged 67–79. The main outcomes are: 1) Changes in proportion of total days of therapy dispensed as generics, and 2) changes in prescription utilization for each therapeutic class. RESULTS: Prescription drug use by these beneficiaries increased by 11% from 2005 to 2006. After adjustment for secular trends and other potential confounders, utilization of each therapeutic class was similar in 2005 and 2006. Small increases in drug utilization occurred for several drug classes, ranging from 0.66 pill days (0.46%) for users of nonsteroidal anti-inflammatories (NSAIDs) to 4.64 pill days (1.78%) for users of angiotensin-converting enzyme (ACE) inhibitors. Decreases occurred for anti-diabetic drugs (–2.06 pill days, –0.58%), betablockers (–1.24, –0.49%), and benzodiazepines (–5.96 pill days, –3.57%). Overall, beneficiaries were slightly less likely to fill prescriptions for generic drugs vs. brand-name drugs in 2006 compared to 2005 (OR 0.98, 95% CI 0.97–0.98). CONCLUSION: Small increases in prescription drug utilization occurred across numerous drug classes for these Medicare seniors following the implementation of the Medicare Part D Prescription Benefit, while overall market share by drug class did not change significantly. Further analyses are needed to explore the degree to which these changes reflect moral hazard versus beneficial expansions of coverage.