Re-evaluation of the cost effectiveness of temozolomide for malignant gliomas in British Columbia.

STUDY OBJECTIVES: To re-evaluate the cost effectiveness and median overall survival (OS) achieved in patients with recurrent malignant gliomas treated with temozolomide in British Columbia, as compared to previous lomustine use in the same patient population based on updated outcomes data. Results were also compared to temozolomide literature reports. METHODS: A retrospective medical record review was performed to identify patients who received single agent temozolomide or lomustine during successive, prespecified time periods. Data were collected on survival, duration of therapy, drug cost, labour and supplies, and successive or prior chemotherapy. RESULTS: Forty-one patients in the temozolomide group and 25 patients in the lomustine group were analysed. The median OS was 33.3 weeks (95% CI 28.4, 42.1 weeks) and 37.7 weeks (95% CI 25.0, 88.4 weeks) respectively (P = 0.783). Temozolomide patients received a mean of 5.1 cycles of drug treatment, with a mean cost per patient of 10746 dollars (CAD). In contrast, lomustine patients received a mean of 3.3 cycles of therapy, with a mean cost per patient of 129 dollars (CAD). The cost-effectiveness analysis showed that temozolomide was generally not a cost-effective strategy and that lomustine was the dominant strategy. In the sensitivity analysis, in scenarios where median OS was prolonged with temozolomide as compared to lomustine, the incremental cost-effectiveness ratio for each life year gained ranged from 32,247 dollars to 162,186 dollars. CONCLUSION: No difference in survival was observed between patients treated with single agent lomustine and temozolomide. Based on the higher cost and lack of additional clinical benefit of temozolomide, lomustine is a more cost-effective treatment strategy.

Advising cancer patients on natural health products--a structured approach.

BACKGROUND: Many patients with cancer (45-60%) use natural health products (NHPs). Pharmacists often find it difficult to advise these patients effectively. OBJECTIVE: To explore pharmacists' perceptions of the information needed to advise cancer patients on NHPs and develop a structured counseling approach. METHODS: A qualitative study was conducted using a focus group of pharmacists from an integrated cancer care organization in Canada. The outcome measures were the definitions of and reasons for the information needed to advise patients on NHPs and a counseling approach using laymen terms. RESULTS: Eight focus group sessions took place, from which 6 categories of information emerged: role of the advisor, evaluation of evidence, assessment of efficacy, assessment of toxicity, monitoring parameters, and provision of a closure. A patient counseling approach was developed based on this information. CONCLUSIONS: The findings provided a description of and rationale for categories of information needed to advise cancer patients on NHPs. A structured, step-by-step approach to counseling these patients was developed.