Assessing health-state utility values in patients with metastatic colorectal cancer: a utility study in the United Kingdom and the Netherlands.

PURPOSE: This study aimed to elicit EuroQol Quality of Life 5-Dimensions (EQ-5D) utility values from patients with second-line metastatic colorectal cancer (mCRC) pre- and post-progression. METHODS: A cross-sectional study was conducted in five hospitals in the Netherlands and the UK. Patients with mCRC were eligible if prescribed a second or subsequent line of therapy or best supportive care (BSC), received prior oxaliplatin in first-line therapy, and had Eastern Cooperative Oncology Group (ECOG) performance status scores of 0-2 at second-line initiation. Patients completed the EuroQol Quality of Life 5-Dimensions 3-levels (EQ-5D-3L) questionnaire and were categorized as pre- or post-progression. Chart data including patient demographics, clinical history, prior/current treatments and serious adverse events (SAEs) were collected. Mean utilities were estimated; uni- and multivariate analyses were conducted. RESULTS: Seventy-five patients were enrolled; 42 were pre-progression defined as second line or third line following an AE on second line and 33 were post-progression defined as third or subsequent therapy lines or BSC. Patient/disease characteristics and number of SAEs were similar between cohorts. Mean utility scores were 0.741 (SD = 0.230) and 0.731 (SD = 0.292) for pre- and post-progression cohorts, respectively. Compared to pre-progression, more patients reported increased anxiety/depression (36 vs. 12 %) and fewer problems with daily activities (64 vs. 38 %) post-progression. More patients pre-progression were on active treatment at enrolment (83 vs. 42 %) compared to post-progression. CONCLUSIONS: This is the first real-world study to collect utilities for patients with second-line mCRC pre- and post-disease progression. Utility values were similar pre- and post-progression. To further explore the effect of radiological progression on utilities, longitudinal research is required that includes patients in palliative care centres.

Systematic review of utilities in abdominal aortic aneurysm.

INTRODUCTION: Two main treatments exist for the repair of abdominal aortic aneurysm (AAA). Open surgical repair has been the standard treatment, but more recently endovascular aneurysm repair (EVAR) has been introduced as a less invasive technique. To compare the long-term outcomes of these, utility outcomes have been suggested to be relevant. OBJECTIVE: To review studies comparing the utility outcomes of open repair and EVAR treatment for AAA. DESIGN: database search with strict inclusion and exclusion criteria. MATERIALS AND METHODS: The search was performed in PubMed and EMBASE covering terms relating to AAA and utility. Studies were analysed qualitatively. RESULTS: 10 studies of AAA met the review criteria. The comparative utility scores for the different treatments varied considerably between studies. A Canadian cohort study estimated EVAR as more favorable than open repair, while randomised controlled trials reported lower utilities with EVAR, except for one month post-surgery in the EVAR 1 trial. Furthermore, after screening for AAA, patients testing positive gave similar QoL-5D scores, but worse visual analogue scores than those testing negative. CONCLUSION: There were few studies calculating utilities in AAA, with inconsistent findings. The limited reporting of data prevents in-depth analysis to explain the differences.

The economic consequences of noncompliance in cardiovascular disease and related conditions: a literature review.

OBJECTIVES: To review studies on the cost consequences of compliance and/or persistence in cardiovascular disease (CVD) and related conditions (hypertension, dyslipidaemia, diabetes and heart failure) published since 1995, and to evaluate the effects of noncompliance on healthcare expenditure and the cost-effectiveness of pharmaceutical interventions. METHODS: English language papers published between January 1995 and February 2007 that examined compliance/persistence with medication for CVD or related conditions, provided an economic evaluation of pharmacological interventions or cost analysis, and quantified the cost consequences of noncompliance, were identified through database searches. The cost consequences of noncompliance were compared across studies descriptively. RESULTS: Of the 23 studies identified, 10 focused on hypertension, seven on diabetes, one on dyslipidaemia, one on coronary heart disease, one on heart failure and three covered multiple diseases. In studies assessing drug costs only, increased compliance/persistence led to increased drug costs. However, increased compliance/persistence increased the effectiveness of treatment, leading to a decrease in medical events and non-drug costs. This offset the higher drug costs, leading to savings in overall treatment costs. In studies evaluating the effect of compliance/persistence on the cost-effectiveness of pharmacological interventions, increased compliance/persistence appeared to reduce cost-effectiveness ratios, but the extent of this effect was not quantified. CONCLUSIONS: Noncompliance with cardiovascular and antidiabetic medication is a significant problem. Increased compliance/persistence leads to increased drug costs, but these are offset by reduced non-drug costs, leading to overall cost savings. The effect of noncompliance on the cost-effectiveness of pharmacological interventions is inconclusive and further research is needed to resolve the issue.

The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review.

OBJECTIVES: To review studies of patient compliance/persistence with cardiovascular or antidiabetic medication published since the year 2000; to compare the methods used to measure compliance/persistence across studies; to compare reported compliance/persistence rates across therapeutic classes and to assess whether compliance/persistence correlates with clinical outcomes. METHODS: English language papers published between January 2000 and November 2005 investigating patient compliance/persistence with cardiovascular or antidiabetic medication were identified through searches of the MEDLINE and EMBASE databases. Definitions and measurements of compliance/persistence were compared across therapeutic areas using contingency tables. RESULTS: Of the 139 studies analysed, 32% focused on hypertension, 27% on diabetes and 13% on dyslipidaemia. The remainder covered coronary heart disease and cardiovascular disease (CVD) in general. The most frequently reported measure of compliance was the 12-month medication possession ratio (MPR). The overall mean MPR was 72%, and the MPR did not differ significantly between treatment classes (range: 67-76%). The average proportion of patients with an MPR of >80% was 59% overall, 64% for antihypertensives, 58% for oral antidiabetics, 51% for lipid-lowering agents and 69% in studies of multiple treatments, again with no significant difference between treatment classes. The average 12-month persistence rate was 63% and was similar across therapeutic classes. Good compliance had a positive effect on outcome in 73% of the studies examining clinical outcomes. CONCLUSIONS: Non-compliance with cardiovascular and antidiabetic medication is a significant problem, with around 30% of days 'on therapy' not covered by medication and only 59% of patients taking medication for more than 80% of their days 'on therapy' in a year. Good compliance has a positive effect on clinical outcome, suggesting that the management of CVD may be improved by improving patient compliance.

Cost-effectiveness of new targeted therapy sunitinib malate as second line treatment in metastatic renal cell carcinoma in Argentina

Objetivo: el objetivo del estudio fue estimar el costo-efectividad del malato de sunitinib versus el mejor cuidado paliativo (best supportive care BSC) en el tratamiento de carcinoma de células renales metastásico resistente a citoquinas (mRCC) en pacientes que fallaron a interleuquina 2 (IL-2), interferón alfa o una combinación de ambos. Métodos: se desarrollo un modelo de Markov y se adaptó a las circunstancias argentinas. Los resultados de efectividad fueron tomados de estudios clínicos y de la base de datos de US Medicare. Los datos fueron ajustados con las estimaciones de mortalidad general de la población tomadas de fuentes argentinas. Las utilidades fueron colectadas con la ayuda del cuestionario EQ-5D en el estudio clínico. La principal fuente de datos de uso de recursos y costos fueron tomados de un instituto oncológico de Argentina. Los costos fueron calculados en pesos argentinos (AR$) de 2006. Tanto los costos como la efectividad fueron descontados a una tasa anual de 3%. El costo-efectividad incremental fue calculado por mes libre de progresión (PFM), año de vida ganado (YLG) y año de vida ajustado por calidad (QALY). Se efectuó un análisis de sensibilidad determinístico y probabilístico para las variables de efectividad y costo.

Introduction: The objective of this study was to estimate the cost-effectiveness of sunitinib malate versus the best palliative care (BSC best supportive care) in the treatment of metastatic renal cell carcinoma resistant to cytokines (MRCC) in patients who failed to interleukin 2 ( IL-2), interferon alpha or a combination of both. Methods: We developed a Markov model and was adapted to the circumstances in Argentina. The results of effectiveness were obtained from clinical studies and the database of U.S. Medicare. The data were adjusted by the estimates of mortality of the population taken from Argentine sources. The utilities were collected with the help of the EQ-5D questionnaire in the clinical study. The main source of data for resource use and costs were taken from an oncology institute in Argentina. The costs were calculated in Argentine pesos (AR $), 2006. Both the costs and effectiveness were discounted at an annual rate of 3%. The cost-effectiveness was estimated by progression-free months (PFM), year of life gained (YLG) and years of life adjusted for quality (QALY). An analysis of deterministic and probabilistic sensitivity for the variables of cost and effectiveness.