Cost-Utility Analysis of Continuation Versus Discontinuation of First-Line Chemotherapy in Patients With Metastatic Squamous-Cell Esophageal Cancer: Economic Evaluation Alongside the E-DIS Trial.
Value Health
; 24(5): 676-682, 2021 05.
Article
en En
| MEDLINE
| ID: mdl-33933236
ABSTRACT
OBJECTIVES:
Continuous chemotherapy has been used to treat patients with metastatic esophageal squamous cell carcinoma (mESCC), despite weak evidence supporting a clinical benefit, associated side effects for the patients, and unjustified medical costs. In the French setting, we conducted a cost-utility analysis alongside the randomized E-DIS trial (NCT01248299), which compared first-line fluorouracil/platinum-based chemotherapy continuation (CT-CONT) to CT discontinuation (CT-DISC) in progressive-free patients after an initial 6-week treatment phase.METHODS:
A partitioned survival analysis was performed using patient-level data collected during the trial for survival outcomes, quality of life (EQ-5D-3L), and medical costs. The mean quality-adjusted life-years (QALYs) and medical costs were estimated over an 18-month period to assess the incremental net monetary benefit and incremental cost-effectiveness ratio. Uncertainty was handled using the nonparametric bootstrap and univariate analysis. Sixty-seven patients with mESCC were randomized and included in the cost-utility analysis.RESULTS:
On average, CT-CONT slightly decreased the number of QALYs (-0.038) and increased the cost per patient (+ 1177). At a willingness-to-pay threshold of 50 000/QALY, the incremental net monetary benefit was negative (-3077 [95% confidence interval -6564; 4359]), and the incremental cost-effectiveness ratio was -30 958/QALY (CT-CONT dominated). The probability of the CT-CONT treatment option being cost-effective at a willingness-to-pay threshold of 50 000/QALY, compared to CT-DISC, was 29%.CONCLUSIONS:
CT-DISC may be considered as an alternative therapeutic option to CT-CONT in patients with mESCC who have stable disease after an initial chemotherapy treatment phase. A continuous chemotherapy could indeed reduce the number of QALYs because of the disutility associated with the continuous treatment.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Neoplasias Esofágicas
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Resultado del Tratamiento
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Análisis Costo-Beneficio
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Fluorouracilo
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Carcinoma de Células Escamosas de Esófago
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Antimetabolitos Antineoplásicos
Tipo de estudio:
Clinical_trials
/
Health_economic_evaluation
Límite:
Female
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Humans
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Male
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Middle aged
País como asunto:
Europa
Idioma:
En
Año:
2021
Tipo del documento:
Article