W Kotowa

A comparison of the estimated costs of erlotinib, docetaxel and pemetrexed for the second-line treatment of non-small cell lung cancer from the German healthcare perspective

Summary The estimated costs of second-line therapy with erlotinib versus docetaxel or pemetrexed were analysed in patients with advanced non-small cell lung cancer (NSCLC) assuming the survival benefits delivered by these three drugs are comparable. Direct total costs to the German statutory health insurance system per patient per quarter were compared, including the impact of grade 3/4 side effects. Resource utilisation data came from clinical studies and/or were supplemented on the basis of guidelines/prescribing information. Basic costs per patient per quarter were: erlotinib €8,172; docetaxel €8,055; and pemetrexed €15,870. Including the cost of managing side effects, the total cost per patient per quarter with erlotinib was €8,376 compared with €9,976 for docetaxel and €16,596 for pemetrexed. The main influence on the cost analysis was the management of haematological side effects associated with docetaxel and to a lesser extent pemetrexed. Sensitivity analyses confirmed the robustness of the results. Based on its favourable side-effect profile, erlotinib offers health economic advantages over docetaxel and pemetrexed in relapsed advanced NSCLC in Germany.

PPN3 ESTIMATED COSTS ASSOCIATED WITH DIFFERENT FRACTURE RISKS RELATED TO OPIOID TREATMENT IN GERMANY

PPN2 COGNITIVE FUNCTION IN CHRONIC NON-MALIGNANT PAIN PATIENTS TREATED WITH EXTENDED-RELEASE MORPHINE SULFATE (AVINZA) Panjabi S, Panjabi R, Lawson KA, Shepherd MD, Barner JC, Johnsrud M Ovation Research Group, a division of ICON Clinical Research, San Francisco, CA, USA, Advanced Pain Management and Rehab, Castro Valley, CA, USA, University of Texas at Austin, Austin,TX, USA, The University of Texas at Austin, Austin,TX, USA OBJECTIVES: To examine the association between extendedrelease, once-daily morphine sulfate (Avinza®, A-MSER) and cognitive function (CF) while controlling for pain intensity (PI), pain-related emotions (PE), pain-related behaviors (PB), and benzodiazepine dose (BD). METHODS: Chronic non-malignant pain patients whose pain was not adequately controlled with short-acting narcotic analgesics and eligible for treatment with A-MSER were enrolled. Patients completed the following assessments at baseline and 4 weeks after stabilization of the A-MSER dose: PI, PE, PB and CF tests measuring short-term memory (digit span test—DST), information processing (paced auditory serial addition test—PASAT), and motor skills (digit symbol test—DSYT). Self-reports of average narcotic dose and BD in the week prior to the assessment were recorded at baseline and follow-up. Three structural equation models were developed; each CF test serving as the dependent variable and other assessments serving as predictor variables. RESULTS: Paired sample ttests showed statistically significant (p < 0.05) improvements in PI, PE, PB, and CF test scores. Chi-square fit statistics showed that the three models with DST (chi-square = 147.79, p = 0.76), DSYT (chi-square = 128.06, p = 0.5), and PASAT (chi-square = 160.39, p = 0.85) fit the data well. In each model, the association between narcotic dose and CF test scores was not statistically significant (p > 0.05) at baseline and follow-up. A statistically significant (p < 0.05) inverse association between BD (1% dose increase) and DSYT scores (0.05% decline) and PASAT scores (0.06% decline) were observed at baseline; the direction of the association persisted but was not significant at follow-up. CONCLUSION: Narcotic therapy does not contribute to cognitive impairment in this sample of chronic pain patients, however, evidence of an inverse dose-dependent association between BD and tests assessing information processing and motor skills was observed.

Comment and Reply on: A comparison of the estimated costs of erlotinib, docetaxel and pemetrexed for the second-line treatment of non-small cell lung cancer from the German healthcare perspective

With the introduction of new agents, outcomes for patients with advanced non-small cell lung cancer (NSCLC) have improved and clinicians now have several effective regimens from which to choose appropriate therapy for their patients. It was therefore with interest that we read the cost comparison of erlotinib, docetaxel and pemetrexed for the second-line treatment of NSCLC that was conducted by Kotowa and colleagues1. Cost differentials between treatment options are an important factor for consideration when selecting a therapeutic strategy, but their determination must be based on sound principles. We have identifi ed a number of methodological issues that we believe may have seriously impacted the validity of the aforementioned analysis.

PDB7 PREDICTORS FOR THE INITIATION OF A BASAL SUPPORTED ORAL THERAPY (BOT) IN TYPE 2 DIABETIC PATIENTS UNDER REAL-LIFE CONDITIONS IN GERMANY

a b s t r a c t Objective: To assess the predictors for the initiation of a basal supported oral therapy (BOT) in type 2 diabetic patients under real-life conditions in Germany. Research design and methods: A historical cohort study based on representative German real life data (IMS® Disease Analyzer) was performed. The study included patients with type 2 diabetes who started an oral antidiabetic drug (OAD) treatment between 01/1995 and 12/2011. Patients with consecutive treatment data for at least 12 months before the initiation of an OAD treatment were eligible for the analysis. The time-dependent rate of patients starting an insulin therapy with a long-acting insulin was calculated by use of the Kaplan–Meier method. Multivariate Cox regression analyses were applied to identify associated factors. Results: The study included 194,967 patients with type 2 diabetes mellitus being on OAD therapy. 24,964 patients were switched to BOT during the observational period. The probability of switching to insulin therapy was associated with three main predictors such as (1) poor metabolic control, (2) midlife age and (3) number and type of the OAD before insulinization. The variation of the HbA1c threshold to HbA1c ≥ 7.5 leads to comparable outcomes with significant HR. Conclusion: The highest probability of initiating a basal supported oral therapy (BOT) under real life conditions was found for patients with poor metabolic control, midlife age and pre-treatment with specific OADs such as SU, GLI or AGI before initiation of insulin therapy.