Docetaxel with prednisone or prednisolone for the treatment of ...

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Economic review
TABLE 18 Summary of published study by Bloomfield and colleagues 64
Authors Bloomfield et al. 64
Date 1998
Type of economic evaluation Cost–utility
Study classification Patient-level data
II. Mixed prospective and retrospective data (type A: RCT)
Currency used CAN$ plus conversion to US$
Year to which costs apply 1996
Perspective used Third-party payer (e.g. Provincial Ministry of Health, insurance company or
managed care plan)
Time frame Extrapolation to lifetime for costs and survival
Comparators 1. Mitoxantrone 12 mg/m 2 (every 3 weeks) plus 5 mg prednisone twice daily
2. 5 mg prednisone twice daily
Source(s) of effectiveness data CCI-NOV22
Source(s) of resource use data CCI-NOV22. Retrospective chart review of a sample of trial patients
(n = 114, 71%)
Source(s) of unit cost data Costs for Ontario were applied:
Admissions to cancer centre – Princess Margaret Hospital (PMH), Toronto
(using hotel method)
Other admissions – Ontario case cost project
Outpatient costs – Ontario Health Insurance Plan (OHIP) fee schedule
Laboratory tests and diagnostic imaging – OHIP fee schedule
Chemotherapy costs – PMH
Other drug costs – Ontario drug benefit formulary
Radiotherapy – PMH + OHIP physician fee
Blood products – Canadian Red Cross
Surgery staff costs – OHIP
Modelling approach used Analysis based on patient-level utility and resource use data from CCI-NOV 22
Summary of effectiveness results Mean quality-adjusted survival:
Mitoxantrone plus prednisone = 41.5 weeks
Prednisone = 28.2 weeks
Difference = 13.3 weeks
Summary of cost results Total per patient cost was estimated at CAN$27,300 for patients randomised to
mitoxantrone plus prednisone (including CAN$14,500 for inpatient care,
CAN$4300 for chemotherapy and CAN$1400 for analgesics) and CAN$29,000
for patients randomised to prednisone (including CAN$19,100 for inpatient
care, CAN$2200 for chemotherapy and CAN$700 for analgesics)
Summary of cost-effectiveness results The baseline estimate showed that mitoxantrone + prednisone dominated
prednisone with a cost-saving of CAN$1700 and an additional 13.3 qualityadjusted
weeks. The ICER associated with the upper 95% CI was CAN$19,700
per QALY gained (calculated using Fieller’s theorem)
Sensitivity analysis One-way sensitivity analyses were conducted by varying the total costs within
each category over a plausible range (inpatient and outpatient ±25%,
laboratory and diagnostic ±50%, surgery ±500%) and to the limits of the 95%
CI. Only variation in the total cost associated with inpatient days caused
mitoxantrone + prednisone to become more costly than prednisone
incurred by the healthcare plan (e.g. visits to the
family physician) was excluded, as was resource use
external to the third-party payer (e.g. incurred by
patients and their families).
The inpatient and outpatient resource use
was measured for different cost categories.
These included inpatient care, outpatient clinic
attendances, chemotherapy drug received,
radiotherapy received, laboratory tests and
diagnostic imaging received and surgery
undertaken. Table 19 provides a breakdown of
the importance of the individual cost categories
as a percentage of the overall cost for each
treatment (taken from Bloomfield and
colleagues). 64