Eva Pirc (Author), Carlo Federici (Author), Maša Bošnjak (Author), Barbara Perić (Author), Matej Reberšek (Author), Leandro Pecchia (Author), Nebojša Glumac (Author), Maja Čemažar (Author), Marko Snoj (Author), Gregor Serša (Author), Damijan Miklavčič (Author)

Abstract

Purpose: Electrochemotherapy is increasingly entering into national and international guidelines, requiring formal evaluation of treatment costs and cost-effectiveness to ensure that its uptake provides value to budget-constrained health care systems. This study analyzed the early cost-effectiveness of electrochemotherapy in patients with Stage IIIc/IV skin melanoma in clinical practice in Slovenia. The costs of electrochemotherapy were compared to those of the standard of care, consisting of palliative treatment and therapy for symptoms. Methods: wThe study enrolled 23 patients treated with electrochemotherapy at the Institute of Oncology (Ljubljana, Slovenia). The mean cost of electrochemotherapy was estimated using patient-specific cost data on electrochemotherapy procedures and subsequent follow-up. Quality-adjusted life-years (QALYs) were estimated by collecting EQ-5D-3L questionnaires at baseline, after complete or partial response following the treatment, and after a relapse of skin lesions. A discrete-time Markov model was built to estimate the lifetime costs and consequences of using electrochemotherapy compared to standard of care, from the perspective of the Slovenian health care system. The analysis was conducted separately in the whole patient sample and in the subset of patients with bleeding lesions. Deterministic and probabilistic sensitivity analyses were conducted to test model assumptions and to characterize the uncertainty around model parameters. Findings: In the whole patient population, electrochemotherapy for skin melanoma Stage IIIc/ IV was expected to increase QALYs by 0.29 (95% credible interval [CrI], 0.10e0.50), at the higher cost of 6568 EUR (95% CrI, 4593e8928) in comparison to the standard of care. At the costeffectiveness threshold of 20,000 EUR/QALY, the estimated probabilities of electrochemotherapy being cost-effective compared to standard of care were 0.30 and 0.91 in the whole patient sample and in patients with bleeding lesions, respectively. In the whole sample population, a 50% reduction in the price of the electrodes was expected to increase the probability of electrochemotherapy being costeffective from 0.30 to ~0.64. Implications: The findings from this costeffectiveness analysis of data from clinical practice were based on a small sample size (ie, 23 patents), which made the subgroup of patients with bleeding lesions very small. Therefore, the findings in this patient population should be carefully interpreted.

Keywords

rak kože;melanom;elektrokemoterapija;elektroporacija;stroškovna učinkovitost;skin cancer;melanoma;electrochemotherapy;electroporation;cost-effectiveness;

Data

Language: English
Year of publishing:
Typology: 1.01 - Original Scientific Article
Organization: UL FE - Faculty of Electrical Engineering
UDC: 616.5
COBISS: 24509699 Link will open in a new window
ISSN: 0149-2918
Views: 76
Downloads: 26
Average score: 0 (0 votes)
Metadata: JSON JSON-RDF JSON-LD TURTLE N-TRIPLES XML RDFA MICRODATA DC-XML DC-RDF RDF

Other data

Secondary language: Slovenian
Secondary keywords: rak kože;melanom;elektrokemoterapija;elektroporacija;stroškovna učinkovitost;
Type (COBISS): Article
Pages: str. 1535-1548
Volume: ǂVol. ǂ42
Issue: ǂno. ǂ8
Chronology: 2020
DOI: 10.1016/j.clinthera.2020.06.013
ID: 15948674
Recommended works:
, uredniki zbornika Marko Boc ... [et al.]
, no subtitle data available