Matthew C Cheung1, Annette E Hay2, Michael Crump2, Kevin R Imrie2, Yuyao Song2, Shazia Hassan2, Nancy Risebrough2, Jonathan Sussman2, Stephen Couban2, David MacDonald2, Vishal Kukreti2, C Tom Kouroukis2, Tara Baetz2, David Szwajcer2, Pierre Desjardins2, Lois Shepherd2, Ralph M Meyer2, Al Le2, Bingshu E Chen2, Nicole Mittmann2. 1. Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD). matthew.cheung@sunnybrook.ca. 2. Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
Abstract
BACKGROUND: The NCIC CTG LY.12 study showed that gemcitabine, dexamethasone, and cisplatin (GDP) were noninferior to dexamethasone, cytarabine, and cisplatin (DHAP) in patients with relapsed or refractory aggressive histology lymphoma prior to autologous stem cell transplantation. We conducted an economic evaluation from the perspective of the Canadian public healthcare system based on trial data. METHODS: The primary outcome was an incremental cost utility analysis comparing costs and benefits associated with GDP vs DHAP. Resource utilization data were collected from 519 Canadian patients in the trial. Costs were presented in 2012 Canadian dollars and disaggregated to highlight the major cost drivers of care. Benefit was measured as quality-adjusted life-years (QALYs) based on utilities translated from prospectively collected quality-of-life data. All statistical tests were two-sided. RESULTS: The mean overall costs of treatment per patient in the GDP and DHAP arms were $19 961 (95% confidence interval (CI) = $17 286 to $24 565) and $34 425 (95% CI = $31 901 to $39 520), respectively, with an incremental difference in direct medical costs of $14 464 per patient in favor of GDP (P < .001). The predominant cost driver for both treatment arms was related to hospitalizations. The mean discounted quality-adjusted overall survival with GDP was 0.161 QALYs and 0.152 QALYs for DHAP (difference = 0.01 QALYs, P = .146). In probabilistic sensitivity analysis, GDP was associated with both cost savings and improved quality-adjusted outcomes compared with DHAP in 92.6% of cost-pair simulations. CONCLUSIONS: GDP was associated with both lower costs and similar quality-adjusted outcomes compared with DHAP in patients with relapsed or refractory lymphoma. Considering both costs and outcomes, GDP was the dominant therapy.
BACKGROUND: The NCIC CTG LY.12 study showed that gemcitabine, dexamethasone, and cisplatin (GDP) were noninferior to dexamethasone, cytarabine, and cisplatin (DHAP) in patients with relapsed or refractory aggressive histology lymphoma prior to autologous stem cell transplantation. We conducted an economic evaluation from the perspective of the Canadian public healthcare system based on trial data. METHODS: The primary outcome was an incremental cost utility analysis comparing costs and benefits associated with GDP vs DHAP. Resource utilization data were collected from 519 Canadian patients in the trial. Costs were presented in 2012 Canadian dollars and disaggregated to highlight the major cost drivers of care. Benefit was measured as quality-adjusted life-years (QALYs) based on utilities translated from prospectively collected quality-of-life data. All statistical tests were two-sided. RESULTS: The mean overall costs of treatment per patient in the GDP and DHAP arms were $19 961 (95% confidence interval (CI) = $17 286 to $24 565) and $34 425 (95% CI = $31 901 to $39 520), respectively, with an incremental difference in direct medical costs of $14 464 per patient in favor of GDP (P < .001). The predominant cost driver for both treatment arms was related to hospitalizations. The mean discounted quality-adjusted overall survival with GDP was 0.161 QALYs and 0.152 QALYs for DHAP (difference = 0.01 QALYs, P = .146). In probabilistic sensitivity analysis, GDP was associated with both cost savings and improved quality-adjusted outcomes compared with DHAP in 92.6% of cost-pair simulations. CONCLUSIONS:GDP was associated with both lower costs and similar quality-adjusted outcomes compared with DHAP in patients with relapsed or refractory lymphoma. Considering both costs and outcomes, GDP was the dominant therapy.
Authors: W Y Cheung; E A Kornelsen; N Mittmann; N B Leighl; M Cheung; K K Chan; P A Bradbury; R C H Ng; B E Chen; K Ding; J L Pater; D Tu; A E Hay Journal: Curr Oncol Date: 2019-04-01 Impact factor: 3.677
Authors: Matthew C Cheung; Nicole Mittmann; Carolyn Owen; Nizar Abdel-Samad; Graeme A M Fraser; Selay Lam; Michael Crump; Catherine Sperlich; Richard van der Jagt; Anca Prica; Stephen Couban; Jennifer A Woyach; Amy S Ruppert; Allison M Booth; Sumithra J Mandrekar; Gail McDonald; Lois E Shepherd; Hope Yen; Bingshu E Chen; Annette E Hay Journal: Clin Lymphoma Myeloma Leuk Date: 2021-07-03
Authors: Anca Prica; Annette E Hay; Michael Crump; Nicole Mittmann; Lois E Shepherd; Ralph M Meyer; Kevin I Imrie; Nancy Risebrough; Marina Djurfeldt; Bingshu E Chen; Matthew C Cheung Journal: Curr Oncol Date: 2021-03-17 Impact factor: 3.677