Economics of mRCC in Italy

1
Economics of mRCC in Italy

• Andrea Belisari, PharmD, MSc,
• Fondazione CHARTA Milano
• Università degli Studi di Milano

2
Issue

• More effective health care interventions than
  what is possible to finance
• Health care resources are limited
• Resources that could be used for one intervention
  are not available for another option
• Some should decide what has to be implemented
• How?

3
Which rational criteria of choice?

• Census
• Chance
• Dice
• Roulette
• T/C
• Time
• Other

4
Economics

• ... study of how societies use scarce resources
  to produce valuable commodities and distribute
  them among different people
• Paul A Samuelson, Nobel Laureate 1970

5
Economic evaluations are...

• One element of the decision, NOT the decision
• aimed NOT at cost containment but at the
  application of economic concepts to health care
• Maximise
• Benefit
• Resources
• Scarce
• Alternative uses (interventions)

C
B
6
Costs and Effects of an intervention
Directs Indirects Intangibles
Directs Indirects Intangibles
C
E
Treatment Adverse effects
Health improvement (Not only) NHS savings
7
Cost-Effectiveness Analysis
Clinical parameters Survival (YOLS)
8
Cost-Utility Analysis
Quality Adjusted Life Years (QALY)
9
Cost-Benefit Analysis
10
Possibile results
-
Costs

Accept (dominant) Evaluate
Evaluate Refuse
Effects
-
11
(No Transcript)
12
Aim

• Assess the cost
• Estimate survival
• Of individuals with incident diagnosis of RCC

13
Methods

• Design
• Retrospective
• Longitudinal
• Naturalistic
• Administrative database
• Epidemiologic and economic study

14
Subjects

• Source population
• Enrollees with a Regional Health Service (1.2
  millions) during 1996 2005
• Study population
• No evidence of cancer (ICD9 140-230) during
  1996-1999
• First RCC diagnosis (ICD9 189) during 2000-2004
• Identification
• From hospital admissions
• Follow-up
• From diagnosis to the first of
• June 2005
• Death
• transfer

15
Information

• Demographic (age and gender)
• vital status
• prescription of drugs
• hospital admissions
• ambulatory procedures

16
Statistical Analysis

• Descriptive
• Clinical and demographic
• Average annual cost
• First year of follow-up
• Subsequent years
• Survival
• Kaplan-Meier

17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
Discussion

• Lack of information on costs, quality of life
• Within direct costs, hospitalisations play the
  principal role
• Patients with metastasis at diagnosis have a
  reduced survival, total cost slightly higher
  which sensitively grows when related versus a
  timing unit (annual)
• New treatments?

21
Prospectives

• Economic Evaluation of sunitinib for the
  First-line Treatment of Metastatic Renal Cell
  Carcinoma in ITALY
• LG Mantovani 1, A Belisari2, F Scaglione3, S de
  Portu1, G Carteni4
• CIRF/Center of Pharmacoeconomics, , University of
  Naples Federico II, Naples
• Fondazione Charta, Milan
• Department of Pharmacological Sciences,
  University of Milan, Milan
• Medical Oncology Department, AORN Cardarelli,
  Naples

22
Objective

• The aim of the study was to asses the
  cost-effectiveness and the cost-utility of
  Sunitinib compared to other first line treatments
  available in Italy for mRCC
• Interferon alfa (IFN-a)
• Interleukin-2
• Bevacizumab associated with IFN-a

23
Methods

• Technique A cost-effectiveness (CEA) and a
  cost-utility analysis (CUA)
• Subjects first line treatment patients with
  mRCC
• Time horizon up to 10 years
• Perspective National Health Service
• Costs Direct medical costs in 2007
• Effects From RCTs

24
Cost and effects
Firs-line treatment IFN-a Sunitinib IL-2 Bevacizumab IFN
Progression-free life years 0.63 1.19 0.70 0.99
LYs 1.77 2.26 1.67 2.19
QALYs 1.11 1.48 1.06 1.39
Total cost (discounted) 32,084 65,115 44,733 81,221
25
Possibile results
-
Costs

Accept (dominant) Evaluate
Evaluate Refuse
Effects
-
26
ICER of sunitinib vs
Compared to IFN-a IL-2 BevacizumabIFN
Incremental cost per PFLY gained 59,496 42,188 Dominant
Incremental cost per LY gained 68,231 34,702 Dominant
Incremental cost per QALY gained 88,433 48,391 Dominant
27
Conclusion (1)

• Who knows, asked Robert Browning, but the world
  may end tonight? True, but on available evidence
  most of us make ready to commute on 830 the next
  day .
• Sir Austin Bradford Hill
• Proceeding of the Royal Society of Medicine, 1965

28
Conclusion (2)

• ...But please do not be discouraged. Our
  experience is that in practice these measurements
  are not as onerous as they may at first appear.
  And our convinction is that these measurements
  are essential for it is better to have an
  approximate measure of the right factors than a
  precise measure of the wrong ones
• Drummond, Stoddard, Torrance, 1987