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Russell HV, Chi YY, Okcu MF, et al. Rising drug cost impacts on cost-effectiveness of 2 chemotherapy regimens for intermediate-risk rhabdomyosarcoma: A report from the Children's Oncology Group. Cancer. 2021;128(2):317-325doi: 10.1002/cncr.33917.
Russell, H. V., Chi, Y. Y., Okcu, M. F., Bernhardt, M. B., Rodriguez-Galindo, C., Gupta, A. A., & Hawkins, D. S. (2022). Rising drug cost impacts on cost-effectiveness of 2 chemotherapy regimens for intermediate-risk rhabdomyosarcoma: A report from the Children's Oncology Group. Cancer, 128(2), 317-325. https://doi.org/10.1002/cncr.33917
Russell, Heidi V, et al. "Rising drug cost impacts on cost-effectiveness of 2 chemotherapy regimens for intermediate-risk rhabdomyosarcoma: A report from the Children's Oncology Group." Cancer vol. 128,2 (2022): 317-325. doi: https://doi.org/10.1002/cncr.33917
Russell HV, Chi YY, Okcu MF, Bernhardt MB, Rodriguez-Galindo C, Gupta AA, Hawkins DS. Rising drug cost impacts on cost-effectiveness of 2 chemotherapy regimens for intermediate-risk rhabdomyosarcoma: A report from the Children's Oncology Group. Cancer. 2022 Jan 15;128(2):317-325. doi: 10.1002/cncr.33917. Epub 2021 Oct 08. PMID: 34623638.
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Cancer. 2022 Jan 15;128(2):317-325. doi: 10.1002/cncr.33917. Epub 2021 Oct 08.

Rising drug cost impacts on cost-effectiveness of 2 chemotherapy regimens for intermediate-risk rhabdomyosarcoma: A report from the Children's Oncology Group.

Cancer

Heidi V Russell, Yueh-Yun Chi, M Fatih Okcu, M Brooke Bernhardt, Carlos Rodriguez-Galindo, Abha A Gupta, Douglas S Hawkins

Affiliations

  1. Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas.
  2. Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas.
  3. Department of Pediatrics and Preventative Medicine, University of Southern California, Los Angeles, California.
  4. St. Jude Children's Research Hospital, Memphis, Tennessee.
  5. Hospital for Sick Children, Toronto, Ontario, Canada.
  6. Seattle Children's Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington.

PMID: 34623638 DOI: 10.1002/cncr.33917

Abstract

BACKGROUND: The Children's Oncology Group clinical trial for intermediate risk rhabdomyosarcoma randomized participants to a combination of vincristine, dactinomycin, and cyclophosphamide (VAC) alone or VAC alternating with vincristine plus irinotecan (VAC/VI). Clinical outcomes were similar, but toxicity profiles differed. This study estimates the cost differences between arms from the health care system's perspective.

METHODS: A decision-analytic model was used to estimate the incremental cost-effectiveness ratio (ICER) of VAC versus VAC/VI. Protocol-required or recommended medications and laboratory studies were included. Costs were obtained from national databases or supporting literature and inflated to 2019 US dollars. Demographic and outcome data were obtained from the clinical trial and directed chart reviews. Life-years (LY) were estimated from life-expectancy tables and discounted by 3% annually. Probabilistic sensitivity analyses and alternative clinical scenarios identified factors driving costs.

RESULTS: Mean direct medical costs of VAC and VAC/VI were $164,757 and $102,303, respectively. VAC was associated with an additional 0.97 LY and an ICER of $64,386/LY compared with VAC/VI. The ICER was sensitive to survival estimations and to alternative clinical scenarios including outpatient cyclophosphamide delivery (ICER $49,037/LY) or substitution of alternative hematopoietic growth factor schedules (ICER $73,191-$91,579/LY). Applying drug prices from 2012 decreased the total costs of VAC by 20% and VAC/VI by 15% because of changes in dactinomycin and pegfilgrastim prices.

CONCLUSIONS: Neither arm was clearly more cost-effective. Pharmaceutical pricing and location of treatment drove costs and may inform future treatment decisions. Rising pharmaceutical costs added $30,000 per patient, a finding important for future drug-pricing policy decisions.

LAY SUMMARY: Two chemotherapy regimens recently tested side-by-side for rhabdomyosarcoma had similar tumor outcomes, but different side effects. The health care costs of each regimen were compared; neither was clearly more cost-effective. However, the costs of each treatment changed dramatically with choices of supportive medicines and location of treatment. Costs of treatment rose by 15% to 20% because of rising US drug costs not associated with the clinical trial.

© 2021 American Cancer Society.

Keywords: cancer; chemotherapy; child; cost-effectiveness; rhabdomyosarcoma

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