Steroid Refractory Chronic Graft-Versus-Host Disease: Cost-Effectiveness Analysis.
Identifieur interne : 000C15 ( Main/Exploration ); précédent : 000C14; suivant : 000C16Steroid Refractory Chronic Graft-Versus-Host Disease: Cost-Effectiveness Analysis.
Auteurs : Fevzi F. Yalniz [États-Unis] ; Mohammad H. Murad [États-Unis] ; Stephanie J. Lee [États-Unis] ; Steven Z. Pavletic [États-Unis] ; Nandita Khera [États-Unis] ; Nilay D. Shah [États-Unis] ; Shahrukh K. Hashmi [Arabie saoudite]Source :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [ 1523-6536 ] ; 2018.
Descripteurs français
- KwdFr :
- MESH :
- tendances : Analyse coût-bénéfice.
- économie : Maladie du greffon contre l'hôte.
- Coûts des soins de santé, Femelle, Humains, Maladie chronique, Mâle.
English descriptors
- KwdEn :
- MESH :
- economics : Graft vs Host Disease.
- trends : Cost-Benefit Analysis.
- Chronic Disease, Female, Health Care Costs, Humans, Male.
Abstract
Given the increasing incidence of chronic graft-versus-host disease (cGVHD) and its rapidly escalating costs due to many lines of drug treatments, we aimed to perform a meta-analysis to assess the comparative effectiveness of various treatment options. Using these results, we then conducted a cost-effectiveness analysis for the frequently utilized agents in steroid-refractory cGVHD. We searched for studies examining tacrolimus, sirolimus, rituximab, ruxolitinib, hydroxychloroquine, imatinib, bortezomib, ibrutinib, extracorporeal photopheresis, pomalidomide, and methotrexate. Studies with a median follow-up period shorter than 6 months and enrolling fewer than 5 patients were excluded. Meta-analysis for overall and organ system-specific GVHD response (overall response [ORR], complete response [CR], and partial response [PR]) was conducted for each intervention. Cost per CR and cost per CR + PR were calculated as the quotient of the 6-month direct treatment cost by CR and CR + PR. Forty-one studies involving 1047 patients were included. CR rates ranged from 7% to 30% with rituximab and methotrexate, respectively, and ORR ranged from 30% to 85% with tacrolimus and ruxolitinib, respectively. Cost per CR ranged from US$1,187,657 with ruxolitinib to US$680 with methotrexate. Cost per ORR ranged from US$453 for methotrexate to US$242,236 for ibrutinib. The most cost-effective strategy was methotrexate for all of the organ systems. Pomalidomide was found to be the least cost-effective treatment for eye, gastrointestinal, fascia/joint, skin, and oral GVHD, and imatinib was found to be the least cost-effective treatment for liver and extracorporeal photopheresis for lung GVHD. We observed huge cost-effectiveness differences among available agents. Attention to economic issues when treating cGVHD is important to recommend how treatments should be sequenced, knowing that many patients will cycle through available agents.
DOI: 10.1016/j.bbmt.2018.03.008
PubMed: 29550629
Affiliations:
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Yalniz</name><affiliation wicri:level="2"><nlm:affiliation>Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Minnesota</region></placeName><wicri:cityArea>Division of Hematology, Department of Medicine, Mayo Clinic, Rochester</wicri:cityArea></affiliation></author><author><name sortKey="Murad, Mohammad H" sort="Murad, Mohammad H" uniqKey="Murad M" first="Mohammad H" last="Murad">Mohammad H. Murad</name><affiliation wicri:level="2"><nlm:affiliation>Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Minnesota</region></placeName><wicri:cityArea>Evidence-Based Practice Center, Mayo Clinic, Rochester</wicri:cityArea></affiliation></author><author><name sortKey="Lee, Stephanie J" sort="Lee, Stephanie J" uniqKey="Lee S" first="Stephanie J" last="Lee">Stephanie J. Lee</name><affiliation wicri:level="2"><nlm:affiliation>Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Washington (État)</region></placeName><wicri:cityArea>Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle</wicri:cityArea></affiliation></author><author><name sortKey="Pavletic, Steven Z" sort="Pavletic, Steven Z" uniqKey="Pavletic S" first="Steven Z" last="Pavletic">Steven Z. 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Shah</name><affiliation wicri:level="2"><nlm:affiliation>Department of Health Services Research, Mayo Clinic, Rochester, Minnesota.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Minnesota</region></placeName><wicri:cityArea>Department of Health Services Research, Mayo Clinic, Rochester</wicri:cityArea></affiliation></author><author><name sortKey="Hashmi, Shahrukh K" sort="Hashmi, Shahrukh K" uniqKey="Hashmi S" first="Shahrukh K" last="Hashmi">Shahrukh K. Hashmi</name><affiliation wicri:level="1"><nlm:affiliation>Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. Electronic address: hashmi.shahrukh@mayo.edu.</nlm:affiliation><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh</wicri:regionArea><wicri:noRegion>Riyadh</wicri:noRegion></affiliation></author></analytic><series><title level="j">Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation</title><idno type="eISSN">1523-6536</idno><imprint><date when="2018" type="published">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Chronic Disease</term><term>Cost-Benefit Analysis (trends)</term><term>Female</term><term>Graft vs Host Disease (economics)</term><term>Health Care Costs</term><term>Humans</term><term>Male</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Analyse coût-bénéfice (tendances)</term><term>Coûts des soins de santé</term><term>Femelle</term><term>Humains</term><term>Maladie chronique</term><term>Maladie du greffon contre l'hôte (économie)</term><term>Mâle</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Graft vs Host Disease</term></keywords><keywords scheme="MESH" qualifier="tendances" xml:lang="fr"><term>Analyse coût-bénéfice</term></keywords><keywords scheme="MESH" qualifier="trends" xml:lang="en"><term>Cost-Benefit Analysis</term></keywords><keywords scheme="MESH" qualifier="économie" xml:lang="fr"><term>Maladie du greffon contre l'hôte</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Chronic Disease</term><term>Female</term><term>Health Care Costs</term><term>Humans</term><term>Male</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Coûts des soins de santé</term><term>Femelle</term><term>Humains</term><term>Maladie chronique</term><term>Mâle</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Given the increasing incidence of chronic graft-versus-host disease (cGVHD) and its rapidly escalating costs due to many lines of drug treatments, we aimed to perform a meta-analysis to assess the comparative effectiveness of various treatment options. Using these results, we then conducted a cost-effectiveness analysis for the frequently utilized agents in steroid-refractory cGVHD. We searched for studies examining tacrolimus, sirolimus, rituximab, ruxolitinib, hydroxychloroquine, imatinib, bortezomib, ibrutinib, extracorporeal photopheresis, pomalidomide, and methotrexate. Studies with a median follow-up period shorter than 6 months and enrolling fewer than 5 patients were excluded. Meta-analysis for overall and organ system-specific GVHD response (overall response [ORR], complete response [CR], and partial response [PR]) was conducted for each intervention. Cost per CR and cost per CR + PR were calculated as the quotient of the 6-month direct treatment cost by CR and CR + PR. Forty-one studies involving 1047 patients were included. CR rates ranged from 7% to 30% with rituximab and methotrexate, respectively, and ORR ranged from 30% to 85% with tacrolimus and ruxolitinib, respectively. Cost per CR ranged from US$1,187,657 with ruxolitinib to US$680 with methotrexate. Cost per ORR ranged from US$453 for methotrexate to US$242,236 for ibrutinib. The most cost-effective strategy was methotrexate for all of the organ systems. Pomalidomide was found to be the least cost-effective treatment for eye, gastrointestinal, fascia/joint, skin, and oral GVHD, and imatinib was found to be the least cost-effective treatment for liver and extracorporeal photopheresis for lung GVHD. We observed huge cost-effectiveness differences among available agents. Attention to economic issues when treating cGVHD is important to recommend how treatments should be sequenced, knowing that many patients will cycle through available agents.</div></front></TEI><affiliations><list><country><li>Arabie saoudite</li><li>États-Unis</li></country><region><li>Arizona</li><li>Maryland</li><li>Minnesota</li><li>Washington (État)</li></region></list><tree><country name="États-Unis"><region name="Minnesota"><name sortKey="Yalniz, Fevzi F" sort="Yalniz, Fevzi F" uniqKey="Yalniz F" first="Fevzi F" last="Yalniz">Fevzi F. Yalniz</name></region><name sortKey="Khera, Nandita" sort="Khera, Nandita" uniqKey="Khera N" first="Nandita" last="Khera">Nandita Khera</name><name sortKey="Lee, Stephanie J" sort="Lee, Stephanie J" uniqKey="Lee S" first="Stephanie J" last="Lee">Stephanie J. Lee</name><name sortKey="Murad, Mohammad H" sort="Murad, Mohammad H" uniqKey="Murad M" first="Mohammad H" last="Murad">Mohammad H. Murad</name><name sortKey="Pavletic, Steven Z" sort="Pavletic, Steven Z" uniqKey="Pavletic S" first="Steven Z" last="Pavletic">Steven Z. Pavletic</name><name sortKey="Shah, Nilay D" sort="Shah, Nilay D" uniqKey="Shah N" first="Nilay D" last="Shah">Nilay D. Shah</name></country><country name="Arabie saoudite"><noRegion><name sortKey="Hashmi, Shahrukh K" sort="Hashmi, Shahrukh K" uniqKey="Hashmi S" first="Shahrukh K" last="Hashmi">Shahrukh K. Hashmi</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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