Virginie Nerich1,2, Camille Fleck3, Loïc Chaigneau4, Nicolas Isambert5, Christophe Borg6,4, Elsa Kalbacher4, Marine Jary4, Pauline Simon7, Xavier Pivot6,4, Jean-Yves Blay8,9,10,11, Samuel Limat3,6. 1. Department of Pharmacy, University Hospital, Boulevard Fleming, 25030, Besançon Cedex, France. v1nerich@chu-besancon.fr. 2. University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions hôte-greffon-tumeur - Ingénierie Cellulaire et Génique, Besançon, France. v1nerich@chu-besancon.fr. 3. Department of Pharmacy, University Hospital, Boulevard Fleming, 25030, Besançon Cedex, France. 4. Department of Medical Oncology, University Hospital, Besançon, France. 5. Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France. 6. University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions hôte-greffon-tumeur - Ingénierie Cellulaire et Génique, Besançon, France. 7. Department of Pediatry, University Hospital, Besançon, France. 8. Department of Medicine, Centre Léon Bérard, Lyon, France. 9. University Claude Bernard, Lyon, France. 10. French Sarcoma Group (GSF-GETO), Paris, France. 11. European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium.
Abstract
INTRODUCTION: The management of advanced gastrointestinal stromal tumors (GISTs) has been modified considerably by the availability of costly tyrosine kinase inhibitors (TKIs); however, the best therapeutic sequence in terms of cost and effectiveness remains unknown. OBJECTIVE: The aim of this study was to compare four potential strategies (reflecting the potential daily practice), each including imatinib 400 mg/day, as first-line treatment: S1 (imatinib400/best supportive care [BSC]); S2 (imatinib400/imatinib800/BSC); S3 (imatinib400/sunitinib/BSC); and S4 (imatinib400/imatinib800/sunitinib/BSC). METHODS: A Markov model was developed with a hypothetical cohort of patients and a lifetime horizon. Transition probabilities were estimated from the results of clinical trials. The analysis was performed from the French payer perspective, and only direct medical costs were included. Clinical and economic parameters were discounted, and the robustness of results was assessed. RESULTS: The least costly and effective strategy was S1, at a cost of €65,744 for 32.9 life months (reference). S3 was the most cost-effective strategy, with an incremental cost-effectiveness ratio (ICER) of €48,277/life-year saved (LYS). S2 was dominated, and S4 yielded an ICER of €363,320/LYS compared with S3. Sensitivity analyses confirmed the robustness of these results; however, when taking into account a price reduction of 80 % for imatinib, S2 and S4 become the most cost-effective strategies. CONCLUSION: Our approach is innovative to the extent that our analysis takes into account the sequential application of TKIs. The results suggest that the S1 strategy is the best cost-effective strategy, but a price reduction of imatinib impacts on the results. This approach must continue, including new drugs and their impact on the quality of life of patients with advanced GISTs.
INTRODUCTION: The management of advanced gastrointestinal stromal tumors (GISTs) has been modified considerably by the availability of costly tyrosine kinase inhibitors (TKIs); however, the best therapeutic sequence in terms of cost and effectiveness remains unknown. OBJECTIVE: The aim of this study was to compare four potential strategies (reflecting the potential daily practice), each including imatinib 400 mg/day, as first-line treatment: S1 (imatinib400/best supportive care [BSC]); S2 (imatinib400/imatinib800/BSC); S3 (imatinib400/sunitinib/BSC); and S4 (imatinib400/imatinib800/sunitinib/BSC). METHODS: A Markov model was developed with a hypothetical cohort of patients and a lifetime horizon. Transition probabilities were estimated from the results of clinical trials. The analysis was performed from the French payer perspective, and only direct medical costs were included. Clinical and economic parameters were discounted, and the robustness of results was assessed. RESULTS: The least costly and effective strategy was S1, at a cost of €65,744 for 32.9 life months (reference). S3 was the most cost-effective strategy, with an incremental cost-effectiveness ratio (ICER) of €48,277/life-year saved (LYS). S2 was dominated, and S4 yielded an ICER of €363,320/LYS compared with S3. Sensitivity analyses confirmed the robustness of these results; however, when taking into account a price reduction of 80 % for imatinib, S2 and S4 become the most cost-effective strategies. CONCLUSION: Our approach is innovative to the extent that our analysis takes into account the sequential application of TKIs. The results suggest that the S1 strategy is the best cost-effective strategy, but a price reduction of imatinib impacts on the results. This approach must continue, including new drugs and their impact on the quality of life of patients with advanced GISTs.
Authors: Sean D Sullivan; Josephine A Mauskopf; Federico Augustovski; J Jaime Caro; Karen M Lee; Mark Minchin; Ewa Orlewska; Pete Penna; Jose-Manuel Rodriguez Barrios; Wen-Yi Shau Journal: Value Health Date: 2013-12-13 Impact factor: 5.725
Authors: Suzanne George; Qian Wang; Michael C Heinrich; Christopher L Corless; Meijun Zhu; James E Butrynski; Jeffrey A Morgan; Andrew J Wagner; Edwin Choy; William D Tap; Jeffrey T Yap; Annick D Van den Abbeele; Judith B Manola; Sarah M Solomon; Jonathan A Fletcher; Margaret von Mehren; George D Demetri Journal: J Clin Oncol Date: 2012-05-21 Impact factor: 44.544
Authors: Charles D Blanke; Cathryn Rankin; George D Demetri; Christopher W Ryan; Margaret von Mehren; Robert S Benjamin; A Kevin Raymond; Vivien H C Bramwell; Laurence H Baker; Robert G Maki; Michael Tanaka; J Randolph Hecht; Michael C Heinrich; Christopher D M Fletcher; John J Crowley; Ernest C Borden Journal: J Clin Oncol Date: 2008-02-01 Impact factor: 44.544