Academic journal article Applied Health Economics and Health Policy

Are the True Impacts of Adverse Events Considered in Economic Models of Antineoplastic Drugs? A Systematic Review

Academic journal article Applied Health Economics and Health Policy

Are the True Impacts of Adverse Events Considered in Economic Models of Antineoplastic Drugs? A Systematic Review

Article excerpt

Published online: 16 October 2013

© Springer International Publishing Switzerland 2013


Background Antineoplastic drugs for cancer are often associated with adverse events, which influence patients' physical health, quality of life and survival. However, the modelling of adverse events in cost-effectiveness analyses of antineoplastic drugs has not been examined.

Aims This article reviews published economic evaluations that include a calculated cost for adverse events of antineoplastic drugs. The aim is to identify how existing models manage four issues specific to antineoplastic drug adverse events: the selection of adverse events for inclusion in models, the influence of dose modifications on drug quantity and survival outcomes, the influence of adverse events on quality of life and the consideration of multiple simultaneous or recurring adverse events.

Methods A systematic literature search was conducted using MESH headings and key words in multiple electronic databases, covering the years 1999-2009. Inclusion criteria for eligibility were papers covering a population of adults with solid tumour cancers, the inclusion of at least one adverse event and the resource use and/or costs of adverse event treatment.

Results From 4,985 citations, 26 eligible articles were identified. Studies were generally of moderate quality and addressed a range of cancers and treatment types. While the four issues specific to antineoplastic drug adverse events were addressed by some studies, no study addressed all of the issues in the same model.

Conclusion This review indicates that current modelling assumptions may restrict our understanding of the true impact of adverse events on cost effectiveness of antineoplastic drugs. This understanding could be improved through consideration of the selection of adverse events, dose modifications, multiple events and quality of life in cost-effectiveness studies.

1 Background

Antineoplastic drugs, which include chemotherapy, are a common cancer treatment. In 2007-2008 there were 260,000 separations for chemotherapy in Australian public and private hospitals combined [1]. However, antineoplastic drugs cause adverse events. More than 750 adverse events are listed in the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI CTCAE),which is used to define and grade the seriousness of adverse events associated with cancer treatments [2]. Adverse events have been estimated to con- tribute up to 60 % of the total cost of chemotherapy [3].

Willingness to pay for cancer treatments in the com- munity is high, owing to a widespread public perception of cancer as a hidden and feared disease [4, 5]. This may lead to a 'treat at all costs' attitude with little consideration given to the economic impacts of these treatments [4, 5]. Economic evaluation is increasingly used to provide information to decision makers in the healthcare system about the relative value of alternative treatment strategies [4]. While such evaluations can be conducted as part of a clinical trial, economic modelling is often used to estimate costs and benefits in the longer term and to take into account different endpoints and comparators [6].

Economic evaluation requires consideration of both the costs and benefits of a treatment, with data used to populate these costs and benefits in the model referred to as inputs. Typically, antineoplastic drugs include three broad cost components-purchasing the antineoplastic products, time and resources for administration of the drugs, and manag- ing adverse events. On the benefit side, disease outcomes such as cancer progression and survival are commonly measured, with quality-of-life measurement required for cost utility analyses. Inputs to economic evaluations for antineoplastic drug outcomes are often readily available through clinical trials, while product purchase costs can be obtained from pricing lists. …

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