Drug Cost Per Gained Month In Overall Survival and Progression

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Drug Cost Per Gained Month In Overall Survival and Progression Free Survival
of Selected Solid Tumour Therapies In Nordic Countries
Abstract 7837
Pia Österlund 1, Per Pfeiffer 2, Rune Smaaland 3, Filipe Rodrigues 4, Gianluca Furneri 5
1 Helsinki University Central Hospital Oncology, Helsinki, Finland; 2 Odense University Hospital, Odense, Denmark; 3 Stavanger University Hospital, Stavanger, Norway; 4 Celgene AB, Kista, Sweden; 5 EBMA Consulting, Melegnano, Italy
METHODS
§  In this analysis treatment costs of drugs indicated in solid
tumours were correlated to their clinical performance, expressed
as absolute efficacy (months of PFS and OS gained) and relative
efficacy vs. trial comparators (% PFS and OS gained).
§  Clinical data of drugs (comparator, treatment duration, PFS, OS)
was retrieved from the European Medicine Agency (EMA)
website [1].
§  Drugs were included in the analyses using the following criteria:
-  Evaluation in trials for 1st line metastatic cancer;
-  EMA approval after year 2000;
-  Indication in high-unmet need tumours (hereby defined as OS
for trial comparator ≤12 months).
§  Total drug cost was calculated using the following methods/
assumptions:
-  Ex-manufacturer hospital prices of drugs [2,3,4,5], expressed
in Euros [6]) were used to calculate per-mg costs, then
multiplied by posology and overall duration of treatment;
-  Costs were calculated minimizing wastage and costs;
-  Posology was determined assuming to treat a hypothetical
patient of 65 Kg, with body surface of 1.65 m2;
-  Concomitant medication costs (i.e. add-on chemotherapy)
were not included in the analysis;
-  Costs of cancer therapies was divided by PFS and OS
months to calculate the cost per PFS and OS month gained.
§  Incidence data for each type of cancer [8] was used to estimate
the possible budget impact for healthcare services (size of
bubbles) and not divided by subgroup (KRAS, BRAF, Her2, etc).
§  10 of 41 drugs (24.4%) in the EMA database fulfilled criteria, with
§ 
§ 
§ 
§ 
melanoma, cancers in the gastrointestinal tract or lung being most
common indications (Figure 1).
Large cost variability was observed among products (Figure 2);
range: €2,010 (tegafur/gimeracil/oteracil) / €74,193 (ipilimumab)
Cost per PFS and OS was quite consistent across countries, while
cost variability among drugs was more evident (Tables 1 and 2).
nab-Paclitaxel ranked fourth in terms of relative PFS benefit and
sixth in terms of OS benefit, while it ranked first among drugs
indicated in cancers of the digestive tracts (Tables 1 and 2).
Good correlation between costs per PFS and OS month and
relative benefit was observed (Figures 3 and 4).
CONCLUSIONS
Figure 1. Results of the drug search.
Drugs indicated in solid tumors
(EMA website)
N=41
Table 1. Costs per month of progression-free survival (€/month), by country.
This study was supported by Celgene Corporation, Summit, NJ. The authors received editorial and production support in the preparation
of this poster from MediTech Media, Ltd, funded by Celgene Corporation. The authors are fully responsible for all content and editorial
decisions for this poster. Conflict of interest: Pia Österlund has received honoraria, travel grants from Roche, Merck, Celgene, Eli Lilly
Nordic drugs; Rune Smaaland has no conflict of interest; Filipe Rodrigues is employed by Celgene; Gianluca Furneri has consultant or
advisory role, remunerated by Celgene
Poster presented at the European Society for Medical Oncology 2014 Congress; September 26-30, 2014; Madrid, Spain
Bevacizumab (Avastin®)
Cetuximab (Erbitux®)
Erlotinib (Tarceva®)
Ipilimumab (Yervoy®)
nab-Paclitaxel (Abraxane®)
Pemetrexed (Alimta®)
Tegafur/gimeracil/oteracil (Teysuno®)
Temsirolimus (Torisel®)
Trastuzumab (Herceptin®)
Vemurafenib (Zelboraf®)
Drugs indicated in high unmet need
tumours
(≤12 months OS in trial control group)
N=10
Indication
(year of EMA approval)
Absolute
(months) and
relative PFS
gain vs. trial
comparator
Bevacizumab
Lung (2007)
Cetuximab
Drug
ACKNOWLEDGMENTS AND DISCLOSURES
http://www.ema.europa.eu/ema/.
2.  National price database: Norway. Available at: http://www.felleskatalogen.no/
medisin.
3.  National price database: Denmark. Available at: http://www.medicinpriser.dk/
default.aspx.
4.  National price database: Finland. Available at: https://easiointi.kela.fi/
laakekys_app/LaakekysApplication?kieli=en.
5.  National price database: Sweden. Available at: http://www.tlv.se/beslut/sok/
lakemedel/
6.  Oanda. Currency conversion (average rates during the period Apr 2013November 2013). Available at: http://www.oanda.com/lang/it/currency/converter/.
7.  Globocan. Estimated cancer incidence in 2012. Available at: http://globocan.iarc.fr/
Pages/summary_table_pop_prev_sel.aspx.
8.  Eurostat. EU population. Available at http://epp.eurostat.ec.europa.eu/portal/page/
portal/population/data/main_tables.
All database searches were performed between November 11th - 15th 2013.
§ 
§ 
§ 
§ 
§ 
§ 
§ 
§ 
§ 
§ 
Drugs approved after year 2000
N=24
€1,795 per OS month and €2,774 per PFS month.
§  These ratios were comparable with those of the other drugs for
high-unmet need solid tumours.
§  Budget impact of pancreatic cancer is reasonable, considered its
incidence rate.
§  Correlation between cost per PFS and OS and clinical unmet
need may allow for the comparison of the health economic
profiles of therapies across indications.
1.  European Medicines Agency. European Public Assessment Reports. Available at:
100
Drugs approved for 1st line treatment
N=27
§  Average cost of nab-Paclitaxel in the Nordic countries was
REFERENCES
Figure 2. Overall treatment costs, by product and country.
Overall treatment costs (€ thousands)
budget allocation decisions in hospitals.
§  This analysis aims to evaluate the cost profile of nanoalbumin
bound paclitaxel (nab-Paclitaxel) in pancreatic cancer vs. other
therapies in high-unmet need solid tumour indications in four
Nordic countries (Denmark, Finland, Norway, Sweden).
CHARTS AND TABLES
Norway
90
60
50
40
30
20
10
0
Total drug cost per PFS month (€)
Drug
Indication
(year of EMA approval)
Absolute
(months) and
relative OS
gain vs. trial
comparator
Finland
Sweden
1.6 (33%)
3,478
2,941
3,114
3,309
Bevacizumab
Lung (2007)
Head and neck (2004)
2.3 (70%)
5,476
5,168
5,101
5,361
Cetuximab
Erlotinib
Pancreas (2006)
0.2 (7%)
1,795
1,485
2,063
1,622
Ipilimumab
Melanoma (2011)
Not available
-
-
-
nab-Paclitaxel
Pancreas (2014)
1.8 (49%)
2,174
2,622
Pemetrexed
Mesothelioma (2004)
1.8 (46%)
3,980
Tegafur
Stomach (2011)
-0.7 (-13)%
Temsirolimus
Kidney (2007)
Trastuzumab
Vemurafenib
250%
200%
Total drug cost per OS month (€)
Norway
Denmark
Finland
Sweden
2.0 (19%)
1,810
1,531
1,620
1,722
Head and neck (2004)
2.7 (36%)
3,036
2,865
2,828
2,972
Erlotinib
Pancreas (2006)
0.4 (7%)
1,052
870
1,209
950
-
Ipilimumab
Melanoma (2011)
4.0 (67%)
8,741
6,725
6,964
7,248
3,096
3,205
nab-Paclitaxel
Pancreas (2014)
1.8 (27%)
1,407
1,697
2,003
2,074
4,004
4,227
4,381
Pemetrexed
Mesothelioma (2004)
2.8 (30%)
1,875
1,886
1,991
2,064
473
423
332
446
Tegafur
Stomach (2011)
0.7 (9%)
264
236
185
249
1.9 (100%)
4,980
3,773
4,048
4,414
Temsirolimus
Kidney (2007)
3.6 (49%)
1,736
1,315
1,411
1,539
Stomach (2009)
1.2 (22%)
3,388
1,959
3,472
3,781
Trastuzumab
Stomach (2009)
2.7 (24%)
1,743
1,008
1,786
1,945
Melanoma (2012)
5.2 (319%)
11,608
9,305
9,530
9,738
Vemurafenib
Melanoma (2012)
3.9 (40%)
5,864
4,700
4,814
4,919
Vemurafenib
Melanoma
y = 0,0003x - 0,6434
R² = 0,90776
Cetuximab
Head and neck
100%
50%
Temsirolimus
Kidney
Pemetrexed
Mesothelioma
0%
Bevacizumab
Lung nab-Paclitaxel
Pancreas
Trastuzumab
Stomach
-50%
10 000
8 000
6 000
Cost per PFS (€/month PFS)
Corresponding author’s email address: [email protected]
Figure 4. Correlation between cost per OS and relative clinical benefits in the Nordic countries.
70%
Size of bubbles proportional to incidence rate [7,8]
= 10-20 cases per 100,000 persons/year
150%
-100%
12 000
Sweden
70
Denmark
300%
Finland
80
Norway
350%
Denmark
Table 2. Costs per month of overall survival (€/month), by country.
Figure 3. Correlation between cost per PFS and relative clinical benefits in the Nordic countries.
PFS gain vs. trial comparator (%)
§  New cancer therapies improve patients’ survival and require
RESULTS
OS gain vs. trial comparator (%)
BACKGROUND AND OBJECTIVES
4 000
Erlotinib
Pancreas
2 000
Tegafur
Stomach
0
Ipilimumab
Melanoma
60%
Size of bubbles proportional to incidence rate [7,8]
= 10-20 cases per 100,000 persons/year
y = 7E-05x + 0,1341
R² = 0,66582
Temsirolimus
Kidney
50%
Cetuximab
Head and neck
Vemurafenib
Melanoma
40%
30%
Pemetrexed
Mesothelioma
20%
Bevacizumab
Lung
10%
0%
8 000
nab-Paclitaxel
Pancreas
Trastuzumab
Stomach
Tegafur
Stomach
Erlotinib
Pancreas
7 000
6 000
5 000
4 000
Cost per OS (€/month OS)
3 000
2 000
1 000
0

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