Steroid Refractory Chronic Graft-Versus-Host Disease: Cost-Effectiveness Analysis.
Identifieur interne : 000123 ( PubMed/Corpus ); précédent : 000122; suivant : 000124Steroid Refractory Chronic Graft-Versus-Host Disease: Cost-Effectiveness Analysis.
Auteurs : Fevzi F. Yalniz ; Mohammad H. Murad ; Stephanie J. Lee ; Steven Z. Pavletic ; Nandita Khera ; Nilay D. Shah ; Shahrukh K. HashmiSource :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [ 1523-6536 ] ; 2018.
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
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Lee</name><affiliation><nlm:affiliation>Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.</nlm:affiliation></affiliation></author><author><name sortKey="Pavletic, Steven Z" sort="Pavletic, Steven Z" uniqKey="Pavletic S" first="Steven Z" last="Pavletic">Steven Z. Pavletic</name><affiliation><nlm:affiliation>Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, Maryland.</nlm:affiliation></affiliation></author><author><name sortKey="Khera, Nandita" sort="Khera, Nandita" uniqKey="Khera N" first="Nandita" last="Khera">Nandita Khera</name><affiliation><nlm:affiliation>Mayo Clinic Cancer Center, Phoenix, Arizona.</nlm:affiliation></affiliation></author><author><name sortKey="Shah, Nilay D" sort="Shah, Nilay D" uniqKey="Shah N" first="Nilay D" last="Shah">Nilay D. Shah</name><affiliation><nlm:affiliation>Department of Health Services Research, Mayo Clinic, Rochester, Minnesota.</nlm:affiliation></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><nlm:affiliation>Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. 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Yalniz</name><affiliation><nlm:affiliation>Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.</nlm:affiliation></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><nlm:affiliation>Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota.</nlm:affiliation></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><nlm:affiliation>Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.</nlm:affiliation></affiliation></author><author><name sortKey="Pavletic, Steven Z" sort="Pavletic, Steven Z" uniqKey="Pavletic S" first="Steven Z" last="Pavletic">Steven Z. Pavletic</name><affiliation><nlm:affiliation>Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, Maryland.</nlm:affiliation></affiliation></author><author><name sortKey="Khera, Nandita" sort="Khera, Nandita" uniqKey="Khera N" first="Nandita" last="Khera">Nandita Khera</name><affiliation><nlm:affiliation>Mayo Clinic Cancer Center, Phoenix, Arizona.</nlm:affiliation></affiliation></author><author><name sortKey="Shah, Nilay D" sort="Shah, Nilay D" uniqKey="Shah N" first="Nilay D" last="Shah">Nilay D. Shah</name><affiliation><nlm:affiliation>Department of Health Services Research, Mayo Clinic, Rochester, Minnesota.</nlm:affiliation></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><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></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="MESH" qualifier="economics" xml:lang="en"><term>Graft vs Host Disease</term></keywords><keywords scheme="MESH" qualifier="trends" xml:lang="en"><term>Cost-Benefit Analysis</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></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><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">29550629</PMID><DateCompleted><Year>2019</Year><Month>07</Month><Day>02</Day></DateCompleted><DateRevised><Year>2019</Year><Month>07</Month><Day>02</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1523-6536</ISSN><JournalIssue CitedMedium="Internet"><Volume>24</Volume><Issue>9</Issue><PubDate><Year>2018</Year><Month>09</Month></PubDate></JournalIssue><Title>Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation</Title><ISOAbbreviation>Biol. Blood Marrow Transplant.</ISOAbbreviation></Journal><ArticleTitle>Steroid Refractory Chronic Graft-Versus-Host Disease: Cost-Effectiveness Analysis.</ArticleTitle><Pagination><MedlinePgn>1920-1927</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S1083-8791(18)30121-6</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.bbmt.2018.03.008</ELocationID><Abstract><AbstractText>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.</AbstractText><CopyrightInformation>Copyright © 2018 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Yalniz</LastName><ForeName>Fevzi F</ForeName><Initials>FF</Initials><AffiliationInfo><Affiliation>Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Murad</LastName><ForeName>Mohammad H</ForeName><Initials>MH</Initials><AffiliationInfo><Affiliation>Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lee</LastName><ForeName>Stephanie J</ForeName><Initials>SJ</Initials><AffiliationInfo><Affiliation>Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pavletic</LastName><ForeName>Steven Z</ForeName><Initials>SZ</Initials><AffiliationInfo><Affiliation>Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, Maryland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Khera</LastName><ForeName>Nandita</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Mayo Clinic Cancer Center, Phoenix, Arizona.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Shah</LastName><ForeName>Nilay D</ForeName><Initials>ND</Initials><AffiliationInfo><Affiliation>Department of Health Services Research, Mayo Clinic, Rochester, Minnesota.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hashmi</LastName><ForeName>Shahrukh K</ForeName><Initials>SK</Initials><AffiliationInfo><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.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2018</Year><Month>03</Month><Day>14</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Biol Blood Marrow Transplant</MedlineTA><NlmUniqueID>9600628</NlmUniqueID><ISSNLinking>1083-8791</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Biol Blood Marrow Transplant. 2018 Sep;24(9):1774-1775</RefSource><PMID Version="1">30016655</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D002908" MajorTopicYN="N">Chronic Disease</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003362" MajorTopicYN="N">Cost-Benefit Analysis</DescriptorName><QualifierName UI="Q000639" MajorTopicYN="Y">trends</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006086" MajorTopicYN="N">Graft vs Host Disease</DescriptorName><QualifierName UI="Q000191" MajorTopicYN="Y">economics</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017048" MajorTopicYN="N">Health Care Costs</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">Allogeneic</Keyword><Keyword MajorTopicYN="Y">Cost</Keyword><Keyword MajorTopicYN="Y">GVHD</Keyword><Keyword MajorTopicYN="Y">Survival</Keyword><Keyword MajorTopicYN="Y">Transplant</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2018</Year><Month>01</Month><Day>09</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2018</Year><Month>03</Month><Day>07</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2018</Year><Month>3</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2019</Year><Month>7</Month><Day>3</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2018</Year><Month>3</Month><Day>19</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">29550629</ArticleId><ArticleId IdType="pii">S1083-8791(18)30121-6</ArticleId><ArticleId IdType="doi">10.1016/j.bbmt.2018.03.008</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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