12th Congress of the European Hematology ... - Haematologica

informed vignettes describing health states involving subcutaneous and
oral administration of ICT. The mean utility values were 0.66 and 0.84
for sub-cutaneous and oral ICT, respectively. The 95% CI for the utility
difference was 0.147-0.212. Utility decrements were applied to
account for the minor adverse events associated with Exjade. The model
was run over a 1-year period and unit costs from 2004/2005 GBP were
applied. Results. In the reference case analysis, Exjade dominates Desferal
with lower aggregate costs and improved quality of life,as shown in
the results Table 1. A range of one- and multi-way sensitivity analyses
are also presented. Conclusions. Exjade fills a current unmet need for iron
chelation via a simple and convenient mode of administration which
significantly reduces the patient burden and improves quality of life.
The reference case cost-effectiveness results show that Exjade provides
more QALYs and costs less than Desferal; in other words, Exjade dominates
DFO.
Table 1.
0599
THE PRICE FOR SURVIVAL ARE ALL PATIENTS EQUAL?
I. Gabriel, 1 M. Schenk, 2 J. Foster, 2 A. Chaidos, 1 E Kanfer, 1 D. Marin, 2
D. Milojkovic, 2 A. Rahemtulla, 2 E. Olavarria, 2 J. Apperley1 1 2 Hammersmith Hospital NHS Trust, LONDON; Hammersmith Hospital,
LONDON, United Kingdom
Background. In the UK hospitals are currently reimbursed for SCT
according to prices negotiated on a regional level and agreed in advance
of the next financial year based on the hospital’s historical and predicted
future activity. By 2008 this arrangement will change to a fixed national
tariff, Payment by results, based on a national average cost of a SCT. It
is currently unclear how this figure will be validated. Aims. We undertook
a comprehensive costing exercise in our institution. We looked at
variability in transplant costs and compared our results to our current
charges. METHOD We selected ten transplants from the three main
transplant modalities: autologous PBSC (ASCT), HLA-matched sibling,
and matched unrelated donor transplants. In each group we selected
patients with shortest and longest inpatient stays. The other eight transplants
were selected at random to include a selection of disease groups,
disease status, patient age, and conditioning regimens. The cost for each
patient transplanted was calculated from the decision to imminently
transplant, to 6 and 12 months for ASCT and allografts respectively. We
reviewed clinical activity from the casenotes and medication charts and
derived investigations from our computerised results system. Using these
data and costs for overheads and utilities, we produced an accurate cost
for each patient. In the case of unrelated allogeneic transplants, donor
search and stem cell procurement were also included. Results. Both myeloablative
and reduced intensity conditioning regimens were included.
In all three transplant types, cost varied considerably. The average price
for an ASCT was 50,575.12 Euros (range 28,932.54-127,083.15 Euros),
for HLA matched sibling SCT, 105,577.39 (range 72,818.26 - 265,038.33
Euros) and for matched unrelated SCT, 154,953.04 Euros (range
56,401.78-265,038.33 Euros). These costs are remarkably similar to those
currently reimbursed with the exception of ASCT (36,000). A wide range
in costs was seen for all aspects of the SCT procedure including donor
search and cell procurement (range 13,807.50 Euros - 35,328.45 Euros),
pharmacy costs (range 2,881.5 Euros - 108,580.5 Euros), and post-transplant
follow up. SCT are inherently heterogeneous and complications are
often unpredictable so the high and wide ranges of costs were not unex-
12 th Congress of the European Hematology Association
pected. Current actual repayments underestimate the costs of ASCT in
particular. The earliest suggestion for the national tariff, underestimates
the cost of all procedures necessitating further accurate negotiations with
our purchasers. Our experience of the Payment by Results consultation
process is that centres are calculating cost in a variety of ways, with differing
Results. We believe that our costs are accurate although we did not
take into account capital asset depreciation. Failure to include all costs
will falsely underestimate costs and the fixed tariff will result in an imbalance
between expenditure and gain. As a result, trusts may have to select
patients for SCT in order to adhere to a fixed price and novel transplants
will no longer be an option. Whilst we admit that the present situation
is not ideal, the speed of introduction of new regulations and the lack of
standardisation is likely to have a detrimental effect on the UK transplant
experience.
0600
COST-EFFECTIVENESS OF CHOP-LIKE CHEMOTHERAPY PLUS RITUXIMAB VERSUS
CHOP-LIKE CHEMOTHERAPY ALONE IN YOUNG PATIENTS WITH GOOD-PROGNOSIS DIF-
FUSE LARGE-B-CELL LYMPHOMA
F. Ferrara, 1 R. Ravasio, 2
1 2 Cardarelli Hospital, Napoli, Italy, NAPOLI; Wolters Kluwer Health, Adis
Internationa, MILANO, Italy
Background. There has been little research into the treatment costs
associated with conventional haematologic drug regimens. Published
economic evaluations focused on the impact of Stem Cell Transplantation
in this therapeutic area. Aims. To estimate the cost-effectiveness of
CHOP-like chemotherapy plus rituximab therapy versus CHOP-like
chemotherapy alone therapy, in young patients with good-prognosis
diffuse large-B-cell lymphoma, based on data from a large international
study (MabThera International Trial MInT Group). Methods. The present
work used a 3 years model in which two cohorts of patients received
CHOP-like chemotherapy plus rituximab or CHOP-like chemotherapy
alone. On the basis of efficacy data derived form the above mentioned
study, the model simulated a complete or non-complete response to the
initial treatment at 5 months and at 3 years. In case of lack of efficacy
the model assumed a rescue-therapy (debulking phase plus autologous
transplant) would be administered to the non-respondent patients. The
analysis was conducted from the perspective of the Italian National
Health Service. The model provided estimates of overall survival (LYs -
Life Years) and direct medical costs (pharmacological treatment, hospitalization,
management of rescue therapy, etc.). Overall survival data
were calculated based on the results of the international study (MInT
Study) and direct medical costs were based on italian treatment patterns
and reported in 2006 Euro. Benefits and costs were discounted at 3%.
One-way sensitivity analysis on key clinical parameters was performed.
Results. The overall survival (per patient) with CHOP-like chemotherapy
plus rituximab versus CHOP-like chemotherapy alone was respectively
19.69 LYs and 17.78 LYs (giving 1,91 LYs Gained). The expected
cost (per patient) was € 23,617.57 with CHOP-like chemotherapy plus
rituximab and € 25,370.08 with CHOP-like chemotherapy alone. Therefore
it was not necessary to calculate the Incremental Cost Effectiveness
Ratio (ICER) of CHOP-like chemotherapy plus rituximab versus CHOPlike
chemotherapy alone, since the former was dominant. The study
results were sensitive to a 5-months complete response and to a 3-years
complete response. Namely, sensitivity analysis simulated the worst
case for CHOP-like chemotherapy plus rituximab with reference to such
parameters. For a 5-months complete response an ICER was calculated
of € 1,273.43 for CHOP-like chemotherapy plus rituximab versus
CHOP-like chemotherapy alone. For a 3-years complete response an
ICER was calculated of € 661.43 for CHOP-like chemotherapy plus rituximab
versus CHOP-like chemotherapy alone. Conclusions. This economic
evaluation suggests that CHOP-like chemotherapy plus rituximab
is a dominant strategy versus CHOP-like chemotherapy alone for
treatment of young patients with good-prognosis diffuse large-B-cell
lymphoma. The sensitivity analysis showed CHOP-like chemotherapy
plus rituximab was a cost-effective approach even in the worst case
assumption.
haematologica/the hematology journal | 2007; 92(s1) | 223