Abstract P5-15-02: The benefit of targeted therapeutics in medical oncology since the development of trastuzumab
Notice bibliographique
Résumé
Abstract Background: Trastuzumab has achieved widespread approval and funding across much of the developed world for metastatic and, later, adjuvant HER2/neu positive breast cancer. This success may be attributed to a favorable therapeutic index and incremental cost-effectiveness ratio (ICER). Has the success of trastuzumab been replicated by newer therapeutics? Methods: The societal marginal benefit gained from a new drug can be estimated by calculating the difference between the incremental quality-adjusted life-years gained (QALY) and the maximum willingness-to-pay (WTP) for the increase in health by society. A systematic review was employed to amass all English-language cost-effectiveness analyses (CEA) on small-molecule inhibitors and monoclonal antibodies approved for the treatment of solid malignancies. Searches of PubMed and EMBASE provided citations published between 1995 and February 5, 2012. Two reviewers each independently assessed the eligibility of all abstracts and subsequently abstracted data from published abstracts and manuscripts. CEAs comparing two experimental treatments to each other were excluded. Incremental costs and ICERs were converted from their native currency to U.S. dollars according to their average exchange-rates since publication. Results: Of the 1,576 citations identified, 60 were included in the final analysis. Tumor-types studied included breast, colorectal, gastric, gastrointestinal stromal, head and neck, non-small cell lung, ovarian, hepatocellular, and renal cancers, and pancreatic neuro-endocrine tumor. Studies originated from USA (14%), continental Europe (37%), England (12%), Canada (12%), Asia (11%), and Latin America (12%). Median WTP was $65,000 (range $30,000-$297,000). 92% of all CEAs included considered to be cost-effective by the CEA's authors. Trastuzumab was studied for breast cancer treatment by 13 CEAs in the adjuvant setting and by 3 CEAs in the metastatic setting. Trastuzumab is significantly more cost-effective than other targeted treatments (mean ICER $32,000 vs. $108,000, p = 0.001). 84% of trastuzumab studies found its ICER<$40,000, but only 32% of other CEAs met this threshold. Trastuzumab may be more cost-effective if employed in the adjuvant setting compared to the metastatic setting (mean ICER $18,000 vs. $29,000, p = 0.12). After trastuzumab, the most favorable treatments by ICER were imatinib for GIST, cetuximab with radiation for head and neck cancer, and sorafenib for hepatocellular carcinoma. There was no apparent relationship between the country of origin in which the CEA was conducted and the ICER estimate. Conclusion: Trastuzumab represents a significant achievement in clinical medicine and also provides greater value than newer targeted chemotherapy, in general. Newer therapeutics are being priced close to the maximum WTP of society. Adjuvant therapy may prove more cost-effective than therapy in the metastatic setting. Unless better pricing arrangements can be made or future therapies produce greater incremental clinical benefits for the same cost, it seems unlikely that the societal success of trastuzumab will be replicated. However, this analysis assumes that maximizing societal health, not profit, is of primary concern. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-15-02.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,012 | 0,059 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,003 | 0,004 |
| Bibliométrie | 0,016 | 0,021 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,016 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».