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Treatment of locally advanced pancreatic carcinoma in Sweden: a health economic comparison of palliative treatment with best supportive care versus palliative treatment with gemcitabine in combination with best supportive care |
Ragnarson-Tennvall G, Wilking N |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Treatment of locally advanced pancreatic carcinoma. The intervention was palliative treatment with gemcitabine in combination with best supportive care.
Economic study type Cost-effectiveness analysis.
Study population Patients diagnosed with locally advanced pancreatic carcinoma who were residents of Stockholm County, Sweden.
Setting Inpatient and outpatient clinics. The study was carried out in Stockholm County, Sweden.
Dates to which data relate Effectiveness and resource use data were collected between April 1994 and March 1995. The price year was 1996.
Source of effectiveness data Effectiveness data were derived from one clinical trial and the information registered in the County Council of Stockholm Register.
Modelling No modelling was undertaken.
Outcomes assessed in the review The review assessed the following outcomes: the number of days of inpatient care, the number of outpatient visits and the number of 1-way journeys.
Study designs and other criteria for inclusion in the review Randomised clinical trial.
Sources searched to identify primary studies Criteria used to ensure the validity of primary studies Methods used to judge relevance and validity, and for extracting data Summary statistics from the trial.
Number of primary studies included One clinical trial and County Council Register.
Methods of combining primary studies Investigation of differences between primary studies Results of the review Patients treated without gemcitabine consume on average 37 days (range: 0 - 300) of inpatient care, 6.4 (range: 0 - 61) outpatient visits, and 8.8 (range: 0 - 64) 1-way journeys. Patients treated with gemcitabine consume on average 2.2 days more inpatient care, 5.5 more outpatient visits, and 5.5 more 1-way journeys.
Measure of benefits used in the economic analysis The measure of benefits was survival from time of diagnosis (number of life years gained).
Direct costs Costs were not discounted since survival was less than 1 year. Quantities and costs were reported separately. Direct costs included the costs of inpatient and outpatient care from the time of diagnosis and costs of transportation to and from hospital. The quantity/cost boundary adopted was that of society. The estimation of quantities and costs was based on actual data. Costs for inpatient and outpatient care were estimated from an existing list of diagnosis-related group prices at Karolinska Hospital, Stockholm, Sweden. Information about unit drug costs was taken from the Swedish drug information source, Pharmaceutical Specialities in Sweden (FASS). The price year was 1996.
Statistical analysis of costs Currency Swedish Kronor (SEK) with US$1 = SEK 6.6.
Sensitivity analysis A sensitivity analysis was conducted on the following parameters: survival period, amount of inpatient and outpatient care, number of chemotherapy cycles, discount rate, costs of transportation, and age limit.
Estimated benefits used in the economic analysis For patients treated without gemcitabine, the mean survival period from diagnosis was 147 days and the median survival period was 55 days. Patients treated with gemcitabine survived an additional 38 days compared with those receiving standard treatment with chemotherapy.
Cost results The marginal cost per patient treated with gemcitabine was SEK 13,771.
Synthesis of costs and benefits The cost per life-year gained was SEK 132,286. The additional cost per patient diagnosed was approximately SEK 4,000 if only patients aged under 65 years old and with an expected survival of more than 28 days were treated. These results were highly sensitive to changes in expected additional survival, the amount of inpatient and outpatient care, and the number of chemotherapy cycles.
Authors' conclusions Treatment with gemcitabine in patients with pancreatic cancer may be a cost-effective alternative, but the results need to be confirmed in future randomised trials.
CRD COMMENTARY - Selection of comparators The rationale for the choice of the comparator was clear. You, as a user of the database, should verify whether these health technologies are relevant to your setting.
Validity of estimate of measure of benefit The measure of benefit is likely to be valid. However, data were collected retrospectively and the comparison was not based on results from a randomised clinical trial. Due to lack of data, information about the effectiveness of gemcitabine treatment was extrapolated from the results of a North American randomised trial. It is not clear whether the North American and Swedish patient populations are comparable with respect to patient selection, stage of disease, if surgery had been performed, etc. A second question is whether the results regarding prolonged survival from the North American trial are transferable to the Swedish patient population.
Validity of estimate of costs All direct costs were included. Costs for community care and costs associated with help from relatives were not calculated.
Other issues These results only apply to patients with pancreatic cancer in Sweden. Given that gemcitabine can improve quality of life (QOL) related symptoms such as pain and performance status, the use of quality-adjusted life years (QALYs) as the measure of benefit is recommended. Finally, it should be noted that not all patients with pancreatic cancer are suitable candidates for chemotherapy because of age, performance status or co-morbidity.
Implications of the study There is a need for further clinical studies and economic evaluations before any definite conclusions can be drawn about the cost-effectiveness of gemcitabine treatment in this patient population.
Source of funding Financial support from Eli Lilly, Sweden.
Bibliographic details Ragnarson-Tennvall G, Wilking N. Treatment of locally advanced pancreatic carcinoma in Sweden: a health economic comparison of palliative treatment with best supportive care versus palliative treatment with gemcitabine in combination with best supportive care. PharmacoEconomics 1999; 15(4): 377-384 Other publications of related interest Glimelius B, Hoffman K, Graf W, Haglund U, Nyren O, Pahlman L, Sjoden P O. Cost-effectiveness of palliative chemotherapy in advanced gastrointestinal cancer. Annals of Oncology 1995;6(3):267-274.
Indexing Status Subject indexing assigned by NLM MeSH Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic /economics /therapeutic use; Deoxycytidine /analogs & Female; Humans; Male; Middle Aged; Palliative Care; Pancreatic Neoplasms /drug therapy /economics /therapy; Survival Analysis; Sweden; derivatives /economics /therapeutic use AccessionNumber 21999008216 Date bibliographic record published 30/04/2000 Date abstract record published 30/04/2000 |
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