Hepatitis C virus infection screening reduces mortality and is cost-effective independently of the intervention test.

INTRODUCTION: Chronic infection due to hepatitis C virus (HCV) is frequently asymptomatic even in advanced stages of liver disease. Implementation of a screening program based on different HCV tests may enable an earlier diagnosis of HCV liver disease and subsequent application of highly effective treatment. PATIENTS AND METHODS: A Markov model which compares three different screening strategies for hepatitis C versus no screening in low-risk prevalence (general population) and high-risk prevalence population (people who inject drugs or prison population) was designed, taking into account age at the start of screening and participation. The three strategies were: 1) serological detection of antibodies against the HCV, 2) dried blood spot test (DBS) to detect antibodies against HCV and 3) detection of RNA from HCV. Quality-adjusted life-years (QALY) were taken as a measurement of effectiveness. The incremental cost-effectiveness ratio (ICER) was calculated and a deterministic and probabilistic sensitivity analysis was performed. RESULTS: All three screening strategies were found to be cost-effective with an ICER of €13,633, €12,015 and €12,328/QALY for AntiHCV, DBS-AntiHCV and DBS-RNA HCV, respectively. There was a decrease in mortality due to liver disease in comparison to no screening for AntiHCV (40.7% and 52%), DBS-AntiHCV (45% and 80%) and DBS-RNA HCV (45.2% and 80%) for low-prevalence and high-prevalence populations, respectively. CONCLUSION: All test interventions for HCV screening are cost-effective for the early detection of HCV infection, also achieving a reduction in mortality. Thus, implementation of screening programs for HCV should not be halted by decisions on monetary policy.

Cost-effectiveness study of closed system transfer devices for the preparation of antineoplastic agents.

Most cytostatic drugs cannot be administered directly to patients in their marketed presentation, but require previous reconstitution conducted in the Pharmacy Unit areas for cytostatic preparation. There are systems that allow drug reconstitution and transfer once it has been diluted, in order to protect staff from any potential contamination during handling. These are commonly known as Closed Systems, and generally have a piece for vial attachment and a syringe adapter with a built-in filter, that replace the traditional needles. Closed systems feature different characteristics and costs which is necessary to analyze in order to determine the most efficient one.

La mayoría de fármacos citostáticos no pueden ser administrados directamente desde la presentación comercial al paciente, sino que requieren de una reconstitución previa realizada en las áreas de elaboración de citostáticos en los Servicios de Farmacia. Existen sistemas que permiten reconstituir y extravasar el fármaco una vez diluido, para evitar la posible contaminación derivada de su manejo al personal. Estos sistemas se conocen comúnmente como sistemas cerrados, y de manera genérica constan de una pieza de fijación al vial y un adaptador para la jeringa con filtro integrado, que sustituyen a las tradicionales agujas. Los sistemas cerrados presentan diversas características y costes que son necesarios analizar para conocer cuál es el sistema más eficiente.

Cost-effectiveness of pemetrexed in combination with cisplatin as first line treatment for patients with advanced non-squamous non-small-cell lung cancer in Spain.

INTRODUCTION: Lung cancer is the third most frequent neoplastic tumour in Spain, with around 27 000 new cases diagnosed per year; 80-95% of these are non-small-cell cancer (NSCLC), and the majority of cases are diagnosed in advanced stages of the disease, and for this reason it is one of the oncologic conditions with higher mortality rates (21.4% mean survival at 5 years). The main treatment regimens used for first-line treatment of NSCLC are: cisplatin/pemetrexed (cis/pem), cisplatin/gemcitabine/ bevacizumab (cis/gem/bev), and carboplatin/paclitaxel/ bevacizumab (carb/pac/bev). The objective of this study was to evaluate the cost-effectiveness ratio of antineoplastic 1st line NSCLC treatment regimens, from the point of view of hospital management. METHODOLOGY: A cost-efficacy mathematical model was prepared, based on a decision tree. The efficacy variable was Progression Free Survival, obtained from the PARAMOUNT, AVAIL and SAIL Phase III clinical trials. The study was conducted from the perspective of the hospital management, considering only the direct costs of drug acquisition. A deterministic sensitivity analysis was conducted to confirm the robustness of outcomes. RESULTS: The PFS obtained in clinical trials with cis/pem, cis/ gem/bev and carb/pac/bev was: 6.9, 6.7 and 6.2 months, respectively. Based on our model, the mean cost of treatment per patient for these regimens was: 19 942 €, 15 594 € and 36 095 €, respectively. The incremental cost-effectiveness ratio per month of additional PFS between cis/pem and cis/gem/bev was 19 303 €. Estimating a 30% reduction in acquisition costs for pemetrexed (Alimta®Eli Lilly Nederland B.V.), due to the forthcoming launch of generic medications, the cis/pem treatment would become the predominant alternative for 1st line treatment of NSCLC patients, by offering the best health results at a lower cost.

Introducción: El cáncer de pulmón es la tercera neoplasia tumoral más frecuente en España, con unos 27.000 nuevos casos/ año, de los que el 80-85% son de etiología no microcítica (NSCLC) y en la mayoría de los casos diagnosticados en estadíos avanzados de la enfermedad, razón por la que es uno de los procesos oncológicos con mayores tasas de mortalidad (supervivencia media a los 5 años del 21,4%). Los principales esquemas de primera línea utilizados en el tratamiento del NSCLC son: cisplatino/pemetrexed (cis/pem), cisplatino/gemcitabina/ bevacizumab (cis/gem/bev), y carboplatino/paclitaxel/bevacizumab (carbo/pac/Bev). El objetivo del presente trabajo consistirá en realizar un análisis para estimar el ratio coste-eficacia de los esquemas antineoplásicos de primera línea en el tratamiento del NSCLC, desde la perspectiva de la gerencia hospitalaria. Metodos: Se elaboró un modelo matemático de coste-eficacia basado en un árbol de decisiones. Como variable de eficacia se utilizó la supervivencia libre de progresión, obtenida de los ensayos clínicos fase III PARAMOUNT, AVAIL y SAIL. El estudio se efectuó desde la perspectiva de la gerencia hospitalaria considerando únicamente los costes directos de adquisición de los fármacos. Se realizó un análisis de sensibilidad determinístico para comprobar la robustez de los resultados. Resultados: La SLP obtenida en los ensayos clínicos de los tratamientos cis/pem, cis/gem/bev y carb/pac/bev fue de: 6,9, 6,7 y 6,2 meses, respectivamente. En base a nuestro modelo, el coste medio del tratamiento por paciente para estos esquemas fue de 19.942 €, 15.594 € y 36.095 €, respectivamente. La razón coste-eficacia incremenal por mes de SLP adicional entre cis/pem y cis/gem/bev fue de 19.303 €. Estimando una reducción del 30% de los costes de adquisición de pemetrexed (Alimta®Eli Lilly Nederland B.V) ante su próxima incorporación al mercado de medicamentos genéricos, el tratamiento cis/pem se convertiría en la alternativa dominante en el tratamiento de primera línea de los pacientes con NSCLC, al ofrecer los mejores resultados en salud a un menor coste.