Cost of interferon-α-2b outweighs benefits in multiple myeloma
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8 INTERNATIONAL RESEARCH & OPINION Cost of interferon-a-2b outweighs benefits in multiple myeloma Adding interferon-a-2b to conventional treatment in patients with multiple myeloma leads to an increase in quality-adjusted life-years (QALYs) gained. However, the gain is small compared with the additional treatment costs. This is the conclusion of investigators from Norway and Sweden who used clinical data from a randomised, multicentre phase III trial for their cost-utility analysis. The phase III trial involved 583 patients (aged 55-80 years) with newly diagnosed, symptomatic multiple myeloma who received conventional treat- ment with melphalan and prednisone (MP) or MP plus interferon-a-2b (MP-IFN).*t SUIVival gain at expense of QOL MP-IFN recipients had a 12% increase in median survival time compared with MP recipients; this difference was not significant. Importantly, MP-IFN recipients experienced a slight reduction in quality of life (QOL)** during the first year of treatment. The investigators used a methodology for transforming the QOL profiles into a single index value on the conventional QALY scale (ranging from 0 to 1). They calculated that treatment with MP-IFN therapy yielded a QALY gain of 0.125/patient. Cost of $USllO OOO/QALY gained Patients in the MP-IFN arm had more hospital days and more home visits by nurses and fewer days in paid employment than patients in the MP arm. The incremental direct cost ofMP-IFN treatment, compared with MP treatment, was SUS 11 700/patient. The incremental indirect cost of lost productivity in the MP-IFN treatment arm was $US2000/patient, compared with MP treatment. Overall, the total incremental cost of MP-IFN treatment from a societal point of view was SUS 13 7000/patient. The estimated incremental cost-utility ratio for MP-IFN over MP was SUS 110 OOO/QALY; this indicates that the QALY gain in the MP-IFN arm was small compared with the additional treatment costs. This ratio was insensitive to changes in cost, but was sensitive to changes in QOL and survival. * Conventional therapy comprised oral melphalan 0.25 mglkg and prednisone 100 mg/day for 4 days every 6 weeks. MP-1FN therapy also included SC interferon-a-2b ['[ntrona· .. Schering Plough] at a dosage of 5 M1U 3 times per week. ** QOL was measured using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire with 12 additional questions pertaining to interferon-CJ.-2b toxicity. t The direct and indirect costs of the 2 treatment regimens were calculated in Norwegian krona (NOK) and US dollars. assuming $US1 = NOK6.40 (1995 values). Costs included those for drug acquisition. hospitalisation, nurse-visits, and lost productivity. Nord E. Wisl0ff F. Hjonh M, Westin J. Cost-utility analysis of melphalan plus prednisone with or without interferon-a2b in newly diagnosed multiple myeloma: results from a randomised controlled trial. l'harmacoEconomics 12: 89-103. Jul1997 """2994 PharmacoEconomics & Ou1comes News 26 Jul 1997 No. 122 1173-5503197/0122-00081$01.00° Adi. International Limited 1997. All right. reserved
Transcript of Cost of interferon-α-2b outweighs benefits in multiple myeloma
8INTERNATIONAL RESEARCH & OPINION
Cost of interferon-a-2b outweighsbenefits in multiple myeloma
Adding interferon-a-2b to conventional treatmentin patients with multiple myeloma leads to an increasein quality-adjusted life-years (QALYs) gained.However, the gain is small compared with the additionaltreatment costs.
This is the conclusion of investigators from Norwayand Sweden who used clinical data from a randomised,multicentre phase III trial for their cost-utilityanalysis. The phase III trial involved 583 patients(aged 55-80 years) with newly diagnosed, symptomaticmultiple myeloma who received conventional treatment with melphalan and prednisone (MP) or MPplus interferon-a-2b (MP-IFN).*t
SUIVival gain at expense of QOL
MP-IFN recipients had a 12% increase in mediansurvival time compared with MP recipients; thisdifference was not significant. Importantly, MP-IFNrecipients experienced a slight reduction in quality oflife (QOL)** during the first year of treatment. Theinvestigators used a methodology for transformingthe QOL profiles into a single index value on theconventional QALY scale (ranging from 0 to 1). Theycalculated that treatment with MP-IFN therapy yielded aQALY gain of 0.125/patient.
Cost of $USllO OOO/QALY gained
Patients in the MP-IFN arm had more hospital daysand more home visits by nurses and fewer days inpaid employment than patients in the MP arm. Theincremental direct cost ofMP-IFN treatment, comparedwith MP treatment, was SUS 11 700/patient. Theincremental indirect cost of lost productivity in theMP-IFN treatment arm was $US2000/patient, comparedwith MP treatment. Overall, the total incremental costof MP-IFN treatment from a societal point of viewwas SUS 13 7000/patient.
The estimated incremental cost-utility ratio forMP-IFN over MP was SUS 110 OOO/QALY; thisindicates that the QALY gain in the MP-IFN arm wassmall compared with the additional treatment costs.This ratio was insensitive to changes in cost, but wassensitive to changes in QOL and survival.* Conventional therapy comprised oral melphalan 0.25 mglkgand prednisone 100 mg/day for 4 days every 6 weeks. MP-1FNtherapy also included SC interferon-a-2b ['[ntrona· .. ScheringPlough] at a dosage of5 M1U 3 times per week.** QOL was measured using the European Organization forResearch and Treatment ofCancer (EORTC) QLQ-C30questionnaire with 12 additional questions pertaining tointerferon-CJ.-2b toxicity.t The direct and indirect costs of the 2 treatment regimens werecalculated in Norwegian krona (NOK) and US dollars. assuming$US1 =NOK6.40 (1995 values). Costs included those for drugacquisition. hospitalisation, nurse-visits, and lost productivity.
Nord E. Wisl0ff F. Hjonh M, Westin J. Cost-utility analysis of melphalan plusprednisone with or without interferon-a2b in newly diagnosed multiplemyeloma: results from a randomised controlled trial. l'harmacoEconomics12: 89-103. Jul1997 """2994
PharmacoEconomics & Ou1comes News 26 Jul 1997 No. 122 1173-5503197/0122-00081$01.00°Adi. International Limited 1997. All right. reserved
