Lien Karen, Cheung Matthew C, Chan Kelvin K W
Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
J Oncol Pract. 2016 Apr;12(4):e369-79. doi: 10.1200/JOP.2015.005876. Epub 2015 Sep 1.
As costs of cancer care rise, there has been a shift to focus on value. Drug wastage affects costs to patients and health care systems without adding value. Historically, cost-effectiveness analyses have used models that assume no drug wastage; however, this may not reflect real-world practices. We sought to identify the frequency of drug wastage modeling in economic evaluations of modern parenteral therapies for hematologic malignancies.
We conducted a systematic literature review of economic evaluations of new US Food and Drug Administration-approved parenteral chemotherapies with indications for the treatment of hematologic malignancies. The primary outcome of interest was the proportion of studies that modeled drug wastage in base-case analyses. If wastage was considered in primary analyses, we reported the impact of wastage on incremental cost-effectiveness ratios (ICERs) and drug acquisition costs.
Wastage was considered in base-case analyses in less than one third of all publications reviewed (12 of 38; 32%). Of these, two studies went on to complete sensitivity analyses and reported significant changes in the calculated ICER as a result. In one study, the ICER increased by 32%, and in the second, accounting for wastage changed a positive ICER to a dominant result.
Potential costs associated with drug wastage are considered in only one third of modern cost-effectiveness models. The impact of wastage on calculated ICERs and drug acquisition costs is potentially substantial. The modeling of wastage in base-case and sensitivity analyses is recommended for future economic evaluations of new intravenous therapies for hematologic malignancies.
随着癌症治疗成本的上升，人们开始转向关注价值。药物浪费增加了患者和医疗保健系统的成本，却没有带来任何价值。从历史上看，成本效益分析所使用的模型假定不存在药物浪费；然而，这可能无法反映实际情况。我们试图确定在现代胃肠外疗法治疗血液系统恶性肿瘤的经济评估中，对药物浪费进行建模的频率。
我们对美国食品药品监督管理局批准的、用于治疗血液系统恶性肿瘤的新型胃肠外化疗药物的经济评估进行了系统的文献综述。主要关注的结果是在基础分析中对药物浪费进行建模的研究比例。如果在主要分析中考虑了浪费情况，我们报告了浪费对增量成本效益比（ICER）和药物采购成本的影响。
在所有纳入综述的出版物中，不到三分之一（38篇中的12篇；32%）的基础分析考虑了药物浪费情况。其中，两项研究继续进行了敏感性分析，并报告了计算得出的ICER因此发生的显著变化。在一项研究中，ICER增加了32%，在另一项研究中，考虑药物浪费后，原本为正值的ICER变为了优势结果。
在现代成本效益模型中，仅有三分之一考虑了与药物浪费相关的潜在成本。浪费对计算得出的ICER和药物采购成本的影响可能很大。建议在未来对治疗血液系统恶性肿瘤的新型静脉疗法进行经济评估时，在基础分析和敏感性分析中对药物浪费进行建模。
