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Sequential Therapies and the Cost-Effectiveness of Treating Metastatic Colon Cancer Patients

BACKGROUND: Technological advances in colon cancer treatment have significantly increased survival outcomes among metastatic patients. With different chemotherapy and biologic regimens administered in first, second, and subsequent lines of treatments, costs and survival outcomes vary considerably. H...

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Detalles Bibliográficos
Autores principales: Woldemichael, Andinet, Onukwugha, Eberechukwu, Seal, Brian, Hanna, Nader, Mullins, C. Daniel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Academy of Managed Care Pharmacy 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10397877/
https://www.ncbi.nlm.nih.gov/pubmed/27231791
http://dx.doi.org/10.18553/jmcp.2016.22.6.628
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author Woldemichael, Andinet
Onukwugha, Eberechukwu
Seal, Brian
Hanna, Nader
Mullins, C. Daniel
author_facet Woldemichael, Andinet
Onukwugha, Eberechukwu
Seal, Brian
Hanna, Nader
Mullins, C. Daniel
author_sort Woldemichael, Andinet
collection PubMed
description BACKGROUND: Technological advances in colon cancer treatment have significantly increased survival outcomes among metastatic patients. With different chemotherapy and biologic regimens administered in first, second, and subsequent lines of treatments, costs and survival outcomes vary considerably. However, there is little evidence on how the type of regime administered in the first line of treatment affects the costs and survival outcomes of the second line of treatment. OBJECTIVE: To examine how the cost-effectiveness of second-line treatment for elderly metastatic colon cancer patients varies by the type of regimen administered in the first line of treatment. METHODS: The Surveillance, Epidemiology and End Results (SEER) cancer registry was used, which is linked with the Medicare claims database, to study elderly metastatic patients diagnosed between 2003 and 2009. Average survivals are estimated using the robust nonparametric Kaplan-Meier method. Selection bias was adjusted for using inverse probability weighting and censoring using robust nonparametric methods of estimating the average of total health care costs. RESULTS: Mean incremental survival was 6.7 months for patients who received second-line treatment (95% CI = 5.7-7.7) compared with those receiving only first-line treatment. However, the mean incremental survival varied between 4 months (95% CI = 0.0-7.3) and 9 months (95% CI = 6.5-11.0) depending on whether fluorouracil with or without leucovorin, irinotecan, oxaliplatin, or other agents were administered in first-line treatment. The mean incremental cost associated with receipt of second-line treatment was $60,231 (95% CI = 52,461-64,198) but ranged between $55,368 (95% CI = 48,294-61,290) and $71,211 (95% CI = 43,168-99,667), depending on the type of regimen administered in the first-line treatment. Combining survival benefits and costs, the incremental cost-effectiveness ratios per life-year gained associated with the receipt of second-line treatment were $97,368 (95% CI = 80,415-117,965); $110,621 (95% CI = 89,560-133,961); $130,689 (95% CI = 101,459-171,918); and $247,951 (95% CI = 112,629808,976) when irinotican, fluorouracil/leucovorin, oxaliplatin, and “other” combinations were, respectively, administered in first-line treatment. In addition, the results varied depending on which statistical method was used. CONCLUSIONS: When therapies are administered in a sequential manner, the cost-effectiveness of the second line of therapy depends on what was administered in the first line of therapy.
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spelling pubmed-103978772023-08-04 Sequential Therapies and the Cost-Effectiveness of Treating Metastatic Colon Cancer Patients Woldemichael, Andinet Onukwugha, Eberechukwu Seal, Brian Hanna, Nader Mullins, C. Daniel J Manag Care Spec Pharm Research BACKGROUND: Technological advances in colon cancer treatment have significantly increased survival outcomes among metastatic patients. With different chemotherapy and biologic regimens administered in first, second, and subsequent lines of treatments, costs and survival outcomes vary considerably. However, there is little evidence on how the type of regime administered in the first line of treatment affects the costs and survival outcomes of the second line of treatment. OBJECTIVE: To examine how the cost-effectiveness of second-line treatment for elderly metastatic colon cancer patients varies by the type of regimen administered in the first line of treatment. METHODS: The Surveillance, Epidemiology and End Results (SEER) cancer registry was used, which is linked with the Medicare claims database, to study elderly metastatic patients diagnosed between 2003 and 2009. Average survivals are estimated using the robust nonparametric Kaplan-Meier method. Selection bias was adjusted for using inverse probability weighting and censoring using robust nonparametric methods of estimating the average of total health care costs. RESULTS: Mean incremental survival was 6.7 months for patients who received second-line treatment (95% CI = 5.7-7.7) compared with those receiving only first-line treatment. However, the mean incremental survival varied between 4 months (95% CI = 0.0-7.3) and 9 months (95% CI = 6.5-11.0) depending on whether fluorouracil with or without leucovorin, irinotecan, oxaliplatin, or other agents were administered in first-line treatment. The mean incremental cost associated with receipt of second-line treatment was $60,231 (95% CI = 52,461-64,198) but ranged between $55,368 (95% CI = 48,294-61,290) and $71,211 (95% CI = 43,168-99,667), depending on the type of regimen administered in the first-line treatment. Combining survival benefits and costs, the incremental cost-effectiveness ratios per life-year gained associated with the receipt of second-line treatment were $97,368 (95% CI = 80,415-117,965); $110,621 (95% CI = 89,560-133,961); $130,689 (95% CI = 101,459-171,918); and $247,951 (95% CI = 112,629808,976) when irinotican, fluorouracil/leucovorin, oxaliplatin, and “other” combinations were, respectively, administered in first-line treatment. In addition, the results varied depending on which statistical method was used. CONCLUSIONS: When therapies are administered in a sequential manner, the cost-effectiveness of the second line of therapy depends on what was administered in the first line of therapy. Academy of Managed Care Pharmacy 2016-06 /pmc/articles/PMC10397877/ /pubmed/27231791 http://dx.doi.org/10.18553/jmcp.2016.22.6.628 Text en © 2016, Academy of Managed Care Pharmacy. All rights reserved. https://creativecommons.org/licenses/by/4.0/This article is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use and redistribution provided that the original author and source are credited.
spellingShingle Research
Woldemichael, Andinet
Onukwugha, Eberechukwu
Seal, Brian
Hanna, Nader
Mullins, C. Daniel
Sequential Therapies and the Cost-Effectiveness of Treating Metastatic Colon Cancer Patients
title Sequential Therapies and the Cost-Effectiveness of Treating Metastatic Colon Cancer Patients
title_full Sequential Therapies and the Cost-Effectiveness of Treating Metastatic Colon Cancer Patients
title_fullStr Sequential Therapies and the Cost-Effectiveness of Treating Metastatic Colon Cancer Patients
title_full_unstemmed Sequential Therapies and the Cost-Effectiveness of Treating Metastatic Colon Cancer Patients
title_short Sequential Therapies and the Cost-Effectiveness of Treating Metastatic Colon Cancer Patients
title_sort sequential therapies and the cost-effectiveness of treating metastatic colon cancer patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10397877/
https://www.ncbi.nlm.nih.gov/pubmed/27231791
http://dx.doi.org/10.18553/jmcp.2016.22.6.628
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