- I have seen the evidence of using network analysis to conduct further cost-effectiveness analysis in two papers. The fractional polynomial models were involved because of nonproportional hazards. I would like to know how to combine the evidence of network meta-analysis with the partitioned survival model in the cost-effectiveness analysis about cancer? What software can be used better? I wonder how the authors connect the two. The abstracts of the two papers are as follows.
- 1. Front Public Health. 2022 Apr 15;10:869960. doi: 10.3389/fpubh.2022.869960.
- eCollection 2022.
- Cost-Effectiveness Analysis of Five Systemic Treatments for Unresectable
- Hepatocellular Carcinoma in China: An Economic Evaluation Based on Network
- Meta-Analysis.
- Zhao M(1)(2), Pan X(1)(2), Yin Y(1)(2), Hu H(1)(2), Wei J(3), Bai Z(3), Tang
- W(1)(2).
- BACKGROUND AND OBJECTIVE: Unresectable hepatocellular carcinoma (uHCC) is the
- main histological subtype of liver cancer and causes a great disease burden in
- China. We aimed to evaluate the cost-effectiveness of five first-line systemic
- treatments newly approved in the Chinese market for the treatment of uHCC,
- namely, sorafenib, lenvatinib, donafenib, sintilimab plus bevacizumab (D + A),
- and atezolizumab plus bevacizumab (T + A) from the perspective of China's
- healthcare system, to provide a basis for decision-making.
- METHODS: We constructed a network meta-analysis of 4 clinical trials and used
- fractional polynomial models to indirectly compare the effectiveness of
- treatments. The partitioned survival model was used for cost-effectiveness
- analysis. Primary model outcomes included the costs in US dollars and health
- outcomes in quality-adjusted life-years (QALYs) and the incremental
- cost-effectiveness ratio (ICER) under a willingness-to-pay threshold of $33,521
- (3 times the per capita gross domestic product in China) per QALY. We performed
- deterministic and probabilistic sensitivity analyses to investigate the
- robustness. To test the effect of active treatment duration on the conclusions,
- we performed a scenario analysis.
- RESULTS: Compared with sorafenib, lenvatinib, donafenib, D + A, and T + A
- regimens, it yielded an increase of 0.25, 0.30, 0.95, and 1.46 life-years,
- respectively. Correspondingly, these four therapies yielded an additional 0.16,
- 0.19, 0.51, and 0.86 QALYs and all four ICERs, $40,667.92/QALY gained,
- $27,630.63/QALY gained, $51,877.36/QALY gained, and $130,508.44/QALY gained,
- were higher than $33,521 except for donafenib. T + A was the most effective
- treatment and donafenib was the most economical option. Sensitivity and scenario
- analysis results showed that the base-case analysis was highly reliable.
- CONCLUSION: Although combination therapy could greatly improve patients with
- uHCC survival benefits, under the current WTP, donafenib is still the most
- economical option.
- 2. Value Health. 2022 May;25(5):796-802. doi: 10.1016/j.jval.2021.10.016. Epub 2021
- Dec 1.
- Cost-Effectiveness of Systemic Treatments for Metastatic Castration-Sensitive
- Prostate Cancer: An Economic Evaluation Based on Network Meta-Analysis.
- Wang L(1), Hong H(2), Alexander GC(1), Brawley OW(3), Paller CJ(4), Ballreich
- J(5).
- OBJECTIVES: To assess the cost-effectiveness of systemic treatments for
- metastatic castration-sensitive prostate cancer from the US healthcare sector
- perspective with a lifetime horizon.
- METHODS: We built a partitioned survival model based on a network meta-analysis
- of 7 clinical trials with 7287 patients aged 36 to 94 years between 2004 and
- 2018 to predict patient health trajectories by treatment. We tested parameter
- uncertainties with probabilistic sensitivity analyses. We estimated drug
- acquisition costs using the Federal Supply Schedule and adopted generic drug
- prices when available. We measured cost-effectiveness by an incremental
- cost-effectiveness ratio (ICER).
- RESULTS: The mean costs were approximately $392 000 with androgen deprivation
- therapy (ADT) alone and approximately $415 000, $464 000, $597 000, and $959 000
- with docetaxel, abiraterone acetate, enzalutamide, and apalutamide, added to
- ADT, respectively. The mean quality-adjusted life-years (QALYs) were 3.38 with
- ADT alone and 3.92, 4.76, 3.92, and 5.01 with docetaxel, abiraterone acetate,
- enzalutamide, and apalutamide, added to ADT, respectively. As add-on therapy to
- ADT, docetaxel had an ICER of $42 069 per QALY over ADT alone; abiraterone
- acetate had an ICER of $58 814 per QALY over docetaxel; apalutamide had an ICER
- of $1 979 676 per QALY over abiraterone acetate; enzalutamide was dominated. At
- a willingness to pay below $50 000 per QALY, docetaxel plus ADT is likely the
- most cost-effective treatment; at any willingness to pay between $50 000 and
- $200 000 per QALY, abiraterone acetate plus ADT is likely the most
- cost-effective treatment.
- CONCLUSIONS: These findings underscore the value of abiraterone acetate plus ADT
- given its relative cost-effectiveness to other systemic treatments for
- metastatic castration-sensitive prostate cancer.
- Badges
- Science topic
More Yi Li's questions See All
Similar questions and discussions