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

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64 Economic model Probability cost-effective given data 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 D + P (3-weekly) and M + P. The ICER of D + P (3-weekly) compared with M + P is £32,706 per additional QALY. Hence the results of Analysis 1 indicate that D + P (3-weekly) is costeffective provided that the NHS is prepared to pay at least this amount per additional QALY. For lower cost-per-QALY thresholds, M + P is costeffective. Figure 6 presents the decision uncertainty in the form of multiple CEACs. The CEACs demonstrate that the probability that D + P (3-weekly) is costeffective increases as the maximum willingness to pay increases: if society is prepared to pay £20,000 for an additional QALY, the probability that D + P (3-weekly) is cost-effective is only around 22%, increasing to 53% if the maximum willingness to pay is £40,000. Although the CEAC provides a useful graphical representation of the uncertainty associated with the probability that individual strategies are costeffective over a range of threshold values, the results of the CEAC can only be used to identify the optimal implementation decision under a restrictive set of assumptions. This is because the strategy with the highest probability of being costeffective does not necessarily have the highest expected pay-off (i.e. net benefit), and will only do D + P (3 weekly) M+P P 0 0 5000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 50,000 Maximum acceptable ratio () (£) FIGURE 6 Cost-effectiveness acceptability curves for the decision between D + P (3-weekly), M + P and P so when the distribution of these pay-offs is symmetrical. 83 This limitation can be overcome by using a cost-effectiveness frontier to indicate which strategy is optimal (and the associated probability that this strategy is the most cost-effective) across the range of values representing the maximum amount the NHS is prepared to pay for an additional QALY. 83 The frontier for this analysis is provided in Figure 7, demonstrating which intervention is cost-effective (and the probability that this intervention is the most cost-effective) across the range of cost-per-QALY thresholds considered. Results for Analysis 2 Table 39 presents the lifetime analysis of the ICER for the comparison of the full range of comparators identified as part of the clinical effectiveness review. In this analysis, eight strategies were considered, including a range of alternative chemotherapy regimens in which docetaxel was used. In this analysis, P and M + P + C are dominated by M + P. In addition, D + P (3-weekly) dominates D + P (weekly) and D + E + P (35 and 70). Although D + E is not dominated by any strategy, it is ruled out of the ICER calculations on the grounds of extended dominance by D + P (3-weekly). Hence, although Analysis 2 includes a broader range of
Probability cost-effective given data 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 D + P (3 weekly) comparators, the final ICER calculations are based on the same non-dominated interventions as in Analysis 1. Consequently, the ICER of D + P (3-weekly) compared with M + P is identical to that presented previously, namely £32,706 per additional QALY. As a result, the same conclusions can be drawn regarding the optimal intervention based on cost-effectiveness considerations. Although the ICER calculations are the same in both Analyses 1 and 2, the addition of more comparators results in increased decision uncertainty. Figure 8 presents the CEACs for © Queen’s Printer and Controller of HMSO 2007. All rights reserved. Health Technology Assessment 2007; Vol. 11: No. 2 0 0 5000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 50,000 Maximum acceptable ratio () (£) FIGURE 7 Cost-effectiveness acceptability frontier for the decision between D + P (3-weekly), M + P and P TABLE 39 Analysis 2 – estimates of mean lifetime costs and QALYs for the full range of potential comparators, together with incremental analysis P Intervention Cost (£) LYG QALY ICER (£) Probability cost-effective (%) £20,000 £30,000 £40,000 M + P + C 11,008 1.47 0.79299 Dominated 25 17 12 P 11,227 1.50 0.81001 Dominated 28 22 16 M + P 10,834 1.51 0.81364 – 18 12 7 D + P (weekly) 26,268 1.57 0.84636 Dominated 0 0 0 D + E + P (70) 16,260 1.60 0.86334 Dominated 8 12 16 D + E + P (35) 18,460 1.68 0.90168 Dominated 1 2 4 D + E 15,036 1.75 0.94209 Extended dominated 13 21 25 D + P (3-weekly) 15,883 1.80 0.96801 32,706 7 14 20 Analysis 2. The CEACs demonstrate that although the probability that D + P (3-weekly) is costeffective increases as the maximum willingness to pay increases, the absolute probabilities are now reduced compared with Analysis 1. If society is prepared to pay £20,000 for an additional QALY, the probability that D + P (3-weekly) is costeffective is now only around 7% (compared with 22% in Analysis 1), increasing to 20% (compared with 53%) if the maximum willingness to pay is £40,000. The increased decision uncertainty surrounding the optimal intervention, across the range of threshold values for the cost per 65
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A systematic review and economic mo
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A systematic review and economic mo
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Objectives: A systematic review was
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Glossary and list of abbreviations
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Glossary Absolute risk reduction Th
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Glossary continued Expected value o
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Glossary continued Progression-free
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List of abbreviations ASCO American
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xvi Executive summary of study desi
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xviii Executive summary prednisone/
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Description of underlying health pr
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● Patients with severe fluid rete
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Search strategy As stated in Chapte
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consensus and, if necessary, a thir
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Quantity of research available A to
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Page 73 and 74: Introduction The review of cost-eff
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Page 104 and 105: 84 References Compendium; 2004. URL
Page 106 and 107: 86 References (D) in patients (pts)
Page 108 and 109: 88 References 100. Aventis Pharma.
Page 110 and 111: 90 References low-dose prednisone i
Page 112 and 113: 92 References 180. Kozloff M, Robin
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Study details Reason for exclusion
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Meeting: 2004 ASCO Annual Meeting C
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Studies of clinical effectiveness w
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Using the method outlined by Parmar
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Appendix 6 Data extraction tables
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Study details and Participant detai
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158 Appendix 7 Ernst et al. 33 Qual
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Appendix 9 © Queen’s Printer and
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Sanofi-Aventis 61 Bloomfield et al.
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Sanofi-Aventis 61 Bloomfield et al.
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168 Appendix 10 TABLE 51 Mean (SD)
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170 Appendix 10 TABLE 54 Distributi
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172 Appendix 10 TABLE 57 Mean stand
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174 Appendix 11 TABLE 63 Drug and a
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176 Appendix 12 Scenario: moderate
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178 Appendix 13 ● You occasionall
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Members Chair, Professor Tom Walley
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Members Chair, Professor Bruce Camp
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Feedback The HTA Programme and the
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