Takeru Shiroiwa

International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?

Although the threshold of cost effectiveness of medical interventions is thought to be 20 000- 30 000 UK pounds in the UK, and

The model-based cost-effectiveness analysis of 1-year adjuvant trastuzumab treatment: based on 2-year follow-up HERA trial data

50 000-

Cost-Effectiveness Analysis of KRAS Testing and Cetuximab as Last-Line Therapy for Colorectal Cancer

100 000 in the US, it is well known that these values are unjustified, due to lack of explicit scientific evidence. We measured willingness-to-pay (WTP) for one additional quality-adjusted life-year gained to determine the threshold of the incremental cost-effectiveness ratio. Our study used the Internet to compare WTP for the additional year of survival in a perfect status of health in Japan, the Republic of Korea (ROK), Taiwan, Australia, the UK, and the US. The research utilized a double-bound dichotomous choice, and analysis by the nonparametric Turnbull method. WTP values were JPY 5 million (Japan), KWN 68 million (ROK), NT

Cost-effectiveness analysis of XELOX for metastatic colorectal cancer based on the NO16966 and NO16967 trials

2.1 million (Taiwan), 23 000 UK pounds (UK), AU

Health utility scores of colorectal cancer based on societal preference in Japan.

64 000 (Australia), and US

Out-of-pocket payment and cost-effectiveness of XELOX and XELOX plus bevacizumab therapy: from the perspective of metastatic colorectal cancer patients in Japan

62 000 (US). The discount rates of outcome were estimated at 6.8% (Japan), 3.7% (ROK), 1.6% (Taiwan), 2.8% (UK), 1.9% (Australia), and 3.2% (US). Based on the current study, we suggest new classification of cost-effectiveness plane and methodology for decision making.

Cost-Effectiveness Analysis of Capecitabine Compared with Bolus 5-Fluorouracil/l-Leucovorin for the Adjuvant Treatment of Colon Cancer in Japan

Background Several randomized controlled trials have confirmed the usefulness of trastuzumab as an adjuvant therapy for HER2-overexpressed breast cancer patients; however, the costs for 1-year treatment are high. Therefore, we performed an economic analysis regarding the efficient distribution of medical resources. Methods To analyze the cost-effectiveness for a 1-year adjuvant trastuzumab treatment group compared with the observation group, we constructed a Markov model adopting a 3% per year discount rate for costs and outcomes. The time horizon was 50xa0years. The perspective was that of health-care payers, as only direct medical costs were calculated. The outcome was measured as life-year gained (LYG) from 2-year follow-up HERA trial data. Results The ICER of the standard setting (5xa0years efficacy and 50–60xa0kg patient weight) was JPYxa02,600,000 (€17,000) per LYG. The calculation results of other weight class ICER were JPYxa02,200,000 (€15,000) and JPYxa03,300,000 (€22,000) per LYG for the patients, respectively, who weighed less than 50xa0kg, and 60–75xa0kg. In the sensitivity analysis, the period of trastuzumab efficacy was the most influential parameter for the result of cost-effectiveness. However, even if the trastuzumab efficacy were to continue for only 2xa0years, at least, which is a conservative setting judging from the joint analysis (NSABP B-31 and NCCTG N9831 trials), the ICER remains acceptable for any weight class. Conclusion These results suggest that the 1-year adjuvant trastuzumab treatment is cost-effective. Both clinical and economic benefits were superior for the 1-year adjuvant trastuzumab treatment group compared with the observation group.

Patient-Reported Outcome Results from the Open-Label Randomized Phase III SELECT BC Trial Evaluating First-Line S-1 Therapy for Metastatic Breast Cancer

AbstractBackground: Cetuximab, a monoclonal antibody directed against the epidermal growth factor receptor, improves progression-free survival and overall survival in patients with metastatic colorectal cancer (mCRC). However, patients with a KRAS gene mutation do not benefit from cetuximab therapy.n Methods: We performed a cost-effectiveness analysis of KRAS testing and cetuximab treatment as last-line therapy for patients with mCRC in Japan. In our analysis, we considered three treatment strategies. In the ‘KRAS-testing strategy’ (strategy A), KRAS testing was performed to guide treatment: patients with wildtype KRAS received cetuximab, and those with mutant KRAS received best supportive care (BSC). In the ‘no -KRAS- testing strategy’ (strategy B), genetic testing was not conducted and all patients received cetuximab. In the ‘no-cetuximab strategy’ (strategy C), genetic testing was not conducted and all patients received BSC. To evaluate the cost effectiveness of KRAS testing, the KRAS- testing strategy was compared with the no-KRAS-testing strategy; to evaluate the cost effectiveness of KRAS testing and cetuximab, the KRAS- testing strategy was compared with the no-cetuximab strategy; and to evaluate the cost effectiveness of cetuximab treatment without KRAS testing, the no-KRAS-testing strategy was compared with the no-cetuximab strategy. A three-state Markov model was used to predict expected costs and outcomes for each group. Outcomes in the model were based on those reported in a retrospective analysis of data from the National Cancer Institute of Canada Clinical Trials Group CO.17 study. We included only direct medical costs from the perspective of the Japanese healthcare payer. A 3% discount rate was used for both costs and outcome. Two outcomes, life-years (LYs) gained and quality-adjusted life-years (QALYs) gained, were used to calculate the incremental cost-effectiveness ratio (ICER).n Results: Our cost-effectiveness analysis revealed that the KRAS-testing strategy was dominant compared with the no-KRAS- testing strategy, with an expected cost reduction of ¥0.5 million per patient and an estimated budget impact of ¥3–5 billion (

Long-Term Eq-5d Score For Patients With Metastatic Breast Cancer; Comparison Of First-Line Oral S-1 And Taxane Therapies In The Randomized “Select” Trial

US42–59 million; July 2010 values) per year. The ICER of the KRAS- testing strategy compared with the no-cetuximab strategy was ¥11 million (

PCN16 COST-EFFECTIVENESS ANALYSIS OF K-RAS TESTING AND CETUXIMAB FOR METASTATIC COLORECTAL CANCER IN JAPAN

US120000) per LY gained and ¥16 million (