Estimation of drug cost avoidance (DCA) and pathology cost avoidance (PCA) through participation in NCIC clinical trials group (NCIC-CTG) phase III clinical trials in Canada.
Bibliographic record
Abstract
6560 Background: Cost avoidance (CA) occurs when, due to the provision of a drug therapy (DCA) or a pathology test (PCA) via trial participation, payment for standard treatment or testing is not required. The aim of this study was to estimate the total DCA and PCA for Canadian patients (pts) enrolled in NCIC-CTG conducted phase 3 trials. Methods: Phase 3 trials that had completed accrual and resulted in DCA or PCA were identified. PCA was calculated based on the number of pts screened and test cost. DCA was estimated based on pts randomized, protocol dosing regimen, drug cost, median dose intensity and median duration of therapy. If this information was incomplete, assumptions were made based on published literature. Costs for Canadian pts accrued are presented in Canadian dollars. No adjustment was made for inflation. Results: From 1999-2011, 4 trials resulted in PCA (1,479 pts) and 17 trials resulted in DCA (3195 pts). Total PCA was estimated at $4,194,849, which included testing for KRAS ($141,058), microsatellite instability ($18,600), and 21-gene recurrence score ($4,035,191). Total DCA was estimated at $27,935,957, of which targeted therapy comprised 42.6% of DCA (5 trials). The combined PCA and DCA was $32,130,806. Conclusions: Over the time period studied, these NCIC-CTG trials resulted in total CA (PCA and DCA) of approximately $7514/pt. Although not all trials lead to CA, these savings should be taken account when considering the financial impact of conducting clinical research. Trial (drug with CA) Mean DCA per pt ($) Total DCA for trial ($) CO.13 (irinotecan) 10,565 1,595,249 CO.20 (cetuximab) 22,588 7,544,519 CRC.2 (oxaliplatin) 13,665 3,689,425 CRC.5 (bevacizumab) 17,430 1,115,520 PA.2 (5FUFA) 93 3,993 MA.27 (exemestane, anastrazole) 9,034 9,519,856 MA.31 (trastuzumab) 31,784 1,239,595 MAC.1 (CMF/AC) 535 6,959 MAC.4 (tamoxifen) 639 21,000 MAC.5 (tamoxifen) 639 39,319 MAC.7 (anastrazole) 2,005 88,209 REC.1 (interferon) 4,290 68,643 OV.16 (paclitaxel) 3,011 710,586 OV.17 (paclitaxel) 4,996 169,858 HN.6 (cisplatin) 90 14,391 LY.12 (rituximab, cytarabine) 6,660 2,104,412 BRC.3 (etoposide) 1,106 4,423
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.036 | 0.082 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.004 |
| Bibliometrics | 0.004 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".