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G Dranitsaris

Publications and source records attributed to G Dranitsaris.

At least 19 recordsLinked to original sources
PubMed2000

Cost-utility analysis of second-line hormonal therapy in advanced breast cancer: a comparison of two aromatase inhibitors to megestrol acetate.

Randomized trials comparing the aromatase inhibitors, anastrozole and letrozole, to megestrol acetate (MA) in postmenopausal women with advanced breast cancer demonstrated that both agents are better tolerated than MA with comparable efficacy. In addition, one trial revealed that tumor response and time to treatment failure were significantly better with letrozole. Since oncologists are faced with a choice between three agents with at least comparable efficacy but different toxicity profiles and cost, a cost-utility analysis was conducted to quantify these differences and to determine if the new agents are more cost-effective than MA. In the absence of a randomized three-arm trial, a decision model was developed to simulate the most common therapeutic outcomes. The clinical data were obtained from an overview analysis of randomized trials. Total hospital resource consumption was collected from 87 patients with advanced disease that had failed second-line hormonal therapy. Utility estimates were obtained from interviewing a random sample of 25 women from the general public and 25 female health care professionals using the Time Trade-Off technique. The model suggested a similar duration of quality-adjusted progression-free survival between drugs (letrozole 150 days, anastrozole 153 days and MA 146 days). Letrozole had an overall cost of Can$2949 per patient which was comparable to MA at Can$2966 per patient. In contrast, anastrozole was slightly more costly than MA at $Can3149 per patient, respectively. The analysis revealed that letrozole has comparable overall costs relative to MA while providing at least equivalent quality-adjusted progression-free survival. These outcomes were largely related to its higher tumor response rate, which translated to a lower proportion of patients requiring chemotherapy. Anastrozole was slightly more costly than MA and did not demonstrate superiority in quality-adjusted progression-free survival in this palliative setting.

Anastrozole↗
PubMed2000

The economic value of a new insulin preparation, Humalog Mix 25. Measured by a willingness-to-pay approach.

OBJECTIVE: To measure the economic value of a new insulin formulation consisting of rapid-acting insulin lispro and intermediate-acting neutral protamine lispro in a 25:75 ratio (Humalog Mix 25). DESIGN AND SETTING: A cost-benefit analysis using a consumer-based willingness-to-pay (WTP) approach was used. The study sample consisted of 80 Canadian taxpayers randomly selected from Ontario and Quebec. After background information on the differences between Humalog Mix 25 and human 30/70 insulin were presented, respondents were asked what their preferred product would be if they were diagnosed with diabetes mellitus. Respondents were then asked the maximum premium that they would pay per month in the form of a user's fee for the insulin of their choice. STUDY PERSPECTIVE: Canadian taxpayer perspective. MAIN OUTCOME MEASURES AND RESULTS: The WTP survey instrument was simple to administer and easily understood by participants. Approximately 84% of the sample of taxpayers preferred to use Humalog Mix 25 rather than human 30/70 insulin and were willing to pay for it (p = 0.012). They were willing to pay a mean of $Can35.28 [95% confidence interval (CI): $Can27.50 to $Can43.07] per month for the benefits offered by Humalog Mix 25, which was at least 2-fold higher than the incremental monthly cost of the drug (1999 values). CONCLUSIONS: The results of the study revealed that Canadians prefer to use Humalog Mix 25 instead of human 30/70 insulin, and they would be willing to pay for it. Compared with other drugs, this overall net gain suggests that Humalog Mix 25 represents good value for money and should be considered for reimbursement by government formularies and other third-party payers.

Adolescent↗
PubMed1999

Author reply

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Journal Article↗
PubMed1999

Cost utility analysis of prophylactic pamidronate for the prevention of skeletal related events in patients with advanced breast cancer.

Metastatic bone disease is a common complication of advanced breast cancer. Recently, the results of a large randomized placebo-controlled trial demonstrated that monthly pamidronate infusions reduce the incidence of skeletal related events in these patients. In the current study, a cost-utility analysis was performed from a Canadian health care system perspective to estimate the incremental cost-effectiveness of pamidronate in patients with advanced breast cancer. Twenty-five advanced breast cancer patients who were bisphosphonate naYve and had developed skeletal related complications were identified. Total hospital resource consumption was then collected for all patients. This included direct costs for hospitalization and costs for radiation treatment to bone, surgery, analgesics, blood products, diagnostic imaging, paramedical services and all related physician fees. Treatment preferences were estimated from a random sample of 25 women selected from the general population and 25 female health care professionals, using the Time Trade-Off technique. The outcomes were then generated through a decision-analytic model. Over a 12-month period, total costs in the pamidronate arm were approximately 44% higher than those in the no-treatment alternative (Can$ 9,180 vs Can$ 6,380). When treatment preferences were incorporated into the analysis, the results of the decision model revealed an incremental pamidronate cost of $18,700 per quality-adjusted life year gained. The results of the sensitivity analysis suggested that this estimate was dependent on the cost of treating skeletal related events, particularly bone surgery. Even though pamidronate has a high drug acquisition cost, the results of the cost-utility analysis suggest that this agent does provide patients with a substantial quality-adjusted survival benefit at a reasonable cost to the Canadian health care system.

Adult↗
PubMed1999

Pamidronate for the prevention of skeletal-related events in multiple myeloma. What does the public think it is worth?

Multiple myeloma is a disorder of the bone marrow that is associated with bone pain and osteolytic lesions. These complications can lead to the development of pathologic fractures and severe patient morbidity. However, the results of a recent randomized trial in patients with multiple myeloma demonstrated that single 90 mg monthly doses of pamidronate as an adjunct to chemotherapy reduced the incidence of skeletal-related events and improved patients' quality of life. A cost-benefit analysis using an ex-ante insurance willingness-to-pay (WTP) approach was conducted from a Canadian societal perspective to estimate the net cost or benefit of prophylactic pamidronate therapy for patients with multiple myeloma. This included direct costs for drug administration and hospital savings secondary to avoiding skeletal-related events. One hundred Canadian taxpayers were then interviewed to ascertain their maximum WTP for the benefits of pamidronate. The WTP survey instrument was simple to administer and easily understood by participants. Respondents stated that they would be willing to pay an average of Can $3,364 (95% CI: $2,096, $4,632) as an income tax increase to be paid over their lifetime for the value offered by the product. The benefit was then subtracted from the overall cost of nine monthly doses of pamidronate ($4,153) producing a net societal cost of $789 per patient (95% CI: (-$479, $2,057). The administration of monthly pamidronate therapy in multiple myeloma patients produces a situation of cost neutrality (societal benefits = costs). Additional clinical trials to identify high-risk patient subgroups that would most benefit from the drug are needed.

Antineoplastic Agents↗
PubMed1999

Cost-utility analysis of chemotherapy using paclitaxel, docetaxel, or vinorelbine for patients with anthracycline-resistant breast cancer.

PURPOSE: Paclitaxel, docetaxel, and vinorelbine have been approved for chemotherapy in patients with advanced breast cancer that is resistant to anthracyclines. Selecting which agent to use is difficult because each possesses advantages and disadvantages related to clinical response, toxicity, method of administration, and cost. A cost-utility analysis was therefore performed to create a rank order on the basis of effectiveness, quality of life, and economic considerations. PATIENTS AND METHODS: Eighty-eight anthracycline-resistant breast cancer patients who had received paclitaxel (n = 34), docetaxel (n = 29), or vinorelbine (n = 25) during the past 2 years were identified. Total resource consumption was collected, which included expenditures for chemotherapy, supportive care, laboratory tests, management of adverse effects, and all related physician fees. Utilities from 25 oncology care providers and 25 breast cancer patients were estimated using the time trade-off technique. The economic estimates from the chart review and clinical data from the literature were then modeled using the principles of decision analysis. RESULTS: Each of the three drugs led to a similar duration of quality-adjusted progression-free survival (paclitaxel, 37.2 days; docetaxel, 33.6 days; vinorelbine, 38.0 days). Vinorelbine was the least costly strategy, with an overall treatment expenditure of Can $3,259 per patient, compared with Can $6,039 and Can $10,090 for paclitaxel and docetaxel, respectively. CONCLUSION: Palliative chemotherapy with vinorelbine in anthracycline-resistant metastatic breast cancer patients has economic advantages over the taxanes and provides at least equivalent quality-adjusted progression-free survival. These benefits are largely related to its lower drug acquisition cost and better toxicity profile.

Adult↗
PubMed1999

Clinical and economic considerations of empirical antibacterial therapy of febrile neutropenia in cancer.

Febrile neutropenia is a condition that can develop in patients with cancer following the administration of myelosuppressive chemotherapy or radiation therapy. The current standard of patient management involves the empirical use of a combination of antibacterials or a single broad spectrum agent to offer extensive antibacterial coverage of both Gram-positive and Gram-negative micro-organisms. Over the past 25 years, febrile neutropenia has changed from a condition that was fatal in over 50% of patients to a condition with an infection-related mortality rate of less than 10%. A major reason behind these extraordinary advances in patient care has been the many well-designed randomised trials of empirical antibacterial therapy that have been conducted over this period of time. In contrast to this finding, a review of the literature revealed limited economic data on the empirical treatment of febrile neutropenia in patients with cancer. Therefore, there is a definite need to conduct more pharmacoeconomic research in this area and to develop methods of implementing the findings of such studies.

Anti-Bacterial Agents↗
PubMed1998

What are cancer patients willing to pay for prophylactic epoetin alfa? A cost-benefit analysis.

BACKGROUND: Anemia, one of the most common complications of cancer chemotherapy, has been managed with red blood cell (RBC) transfusions. As an alternative, the agent epoetin alfa has the potential to reduce the transfusion requirements of patients receiving cancer chemotherapy. To estimate the value that cancer patients place on the drug, an economic analysis using the concept of willingness to pay (WTP) was conducted. METHODS: The method of WTP was used within the framework of a classical cost-benefit analysis to estimate the net cost or benefit of administering prophylactic epoetin alfa to cancer patients. This estimate included the direct cost of epoetin alfa administration and savings secondary to reduced RBC transfusions. A cohort of 100 cancer patients who received or were scheduled to receive cisplatin or noncisplatin chemotherapy (50 per group) were then interviewed to measure the maximum WTP (net benefit) that they experienced with epoetin alfa. RESULTS: Regarding the benefits they would experience after 3 months of epoetin alfa administration, patients receiving cisplatin and noncisplatin therapy stated that they would be willing to pay an average of 587 U.S. dollars (U.S.$587) (95%CI: $300-$875) and U.S.$613 (95%CI: $324-$902), respectively. These benefits were then subtracted from the total cost of the drug when administered to patients receiving cisplatin (U.S.$3530) and noncisplatin (U.S.$3653) therapy. This produced a net incremental treatment cost of U.S.$2943 (95%CI: $2655-$3230) and U.S.$3039 (95%CI: $2750-$3328) for the respective treatment groups. CONCLUSIONS: The results of the current study suggest that the routine administration of epoetin alfa to cancer patients receiving myelosuppressive chemotherapy is a highly resource-intensive treatment policy with modest benefit to patients. Additional research is required to identify high risk patient subgroups who would benefit most from the drug. [See editorial on pages 2427-9, this issue.]

Anemia↗
PubMed1998

A clinical and economic evaluation of red blood cell transfusions in patients receiving cancer chemotherapy.

A clinical and economic evaluation of red blood cell (RBC) utilization in cancer patients during chemotherapy is described. Using a randomized sampling process, 100 patients who had received chemotherapy with or without cisplatin were selected (50 in each group). Multiple logistic regression was then used to identify risks factors for transfusion requirements. Twenty-five percent of patients in the cisplatin and 12% in the noncisplatin group received at least one blood transfusion during chemotherapy (p = .09). Depressed hemoglobin levels and cisplatin dosage were identified as risk factors for transfusion requirements. Combining all transfused patients revealed an overall cost of Can $599 (95% CI: $513-$683) per transfusion. The results of the current study indicated that anemia is a common complication of cancer chemotherapy that can be costly to manage.

Anemia↗
PubMed1998

Clinical and economic analysis of allogeneic peripheral blood progenitor cell transplants: a Canadian perspective.

Allogeneic peripheral blood progenitor cell (PBPC) transplants are an alternative to BMT, although G-CSF mobilization dose, timing of pheresis and risk of GVHD are not well defined. We compared harvest characteristics, donor and recipient outcomes and costs of two PBPC transplant strategies with historical controls who received BMT. Twenty donors mobilized with four daily s.c. G-CSF doses (5 microg/kg/day) (group 1) and 20 mobilized with 10 microg/kg/day G-CSF (group 2) were compared with 20 BM controls (group 3). G-CSF and phereses were well tolerated. Four of 40 PBPC donors required femoral catheter placement. At least 2.5 x 10(6) CD34+/kg recipient weight were collected with two phereses in 19/20 donors (group 1) and 18/20 donors (group 2). Time to neutrophil (18 vs 20 vs 22 days, P = 0.02) and platelet (21 vs 24 vs 27 days, P = 0.005) engraftment was shorter in the PBPC groups (group 2 vs group 1 vs group 3) but secondary engraftment outcomes were not different. The incidence of grade 2-4 aGVHD was higher in the low-dose G-CSF group (group 1) but there was no difference in cGVHD, 100-day or 1-year survival. The mean PBPC transplant cost (group 1) at first hospital discharge was less than BM (group 3) ($34,643 vs $37,354) but the mean overall cost for both groups was similar at 100 days ($46,334 vs $46,083). Allogeneic PBPC transplant with short course, low-dose G-CSF mobilization is safe, feasible and cost equivalent to allogeneic BMT.

Bone Marrow Transplantation↗
PubMed1998

Treatment of non-Hodgkin's lymphoma.

Non-Hodgkin's lymphoma (NHL) is the most common type of lymphoid malignancy that affects over 40000 people in North American alone. The difficulty associated with NHL is correctly assigning patients into homogenous histologic subtypes. Appropriate classification is of paramount importance because the multiple subgroups are associated with distinct clinical outcomes. Current anticancer therapy for this heterogenous disease includes chemotherapy, radiation, cytokine administration and dose-intensive myeloablative antineoplastic treatments followed by autologous bone marrow rescue. With the optimal management strategy, approximately 50% of patients with aggressive NHL can achieve prolonged disease-free survival and even clinical cures. This article will review current therapies for NHL, and discuss some recent advances in the clinical application of prognostic factors, cytokines and the role of transplantation.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

Economic analysis of fluconazole versus amphotericin B for the treatment of candidemia in non-neutropenic patients.

Fluconazole (FLU) is an alternative to amphotericin B (AMB) for the treatment of candidemia in non-neutropenic patients. This agent has similar clinical efficacy but significantly reduced adverse effects compared with AMB. Using the database from a Canadian randomised multicentre comparative trial of FLU versus AMB in the treatment of non-neutropenic patients with candidemia, an economic analysis of antifungal therapy was conducted from a Canadian hospital perspective. Patient records were examined for information containing hospital resource consumption. This included the costs for primary intravenous therapy with either AMB or FLU, laboratory tests, patient clinical monitoring and adverse effects management. The robustness of the baseline results were then tested by a comprehensive sensitivity analysis. The mean duration of therapy in the AMB and FLU arms was 17.1 and 23.7 days, respectively (p < 0.001). Assuming that all of the FLU was administered intravenously, the outcomes of the baseline economic analysis revealed that the treatment cost for patients randomized to receive FLU was approximately 50% higher than that for patients treated with AMB [AMB: $Can2370 vs FLU: $Can3578; p = 0.001 ($Can = Canadian dollars)]. In the sensitivity analysis, substitution to oral FLU after 7 days of intravenous therapy produced economic differences that were no longer statistically significant (AMB: $Can2370 vs FLU: $Can2705; p = 0.10). These results suggest that the FLU administration regimen used in the Canadian randomized trial for the treatment of candidemia in non-neutropenic patients may result in increased hospital costs compared with AMB. However, comparable expenditures could be realized if FLU is administered intravenously for the first 7 days and then orally in patients whose condition allows for reliable oral therapy.

Adult↗
PubMed1997

Cost-utility analysis of paclitaxel in combination with cisplatin for patients with advanced ovarian cancer.

The standard treatment for patients with advanced ovarian cancer (AOC) has been cyclophosphamide and cisplatin (CP). Recently, the results of a large randomized comparative trial demonstrated that the combination of paclitaxel and cisplatin (TP) provided a progression-free survival benefit of 5 months. In this study, a cost-utility analysis was performed from a Canadian health care system perspective to estimate the incremental cost-effectiveness of the TP combination. Twelve AOC patients who received treatment with TP were matched for age and disease stage on a 1-to-2 basis with a CP control. Total hospital resource consumption was then collected for all patients. Treatment preferences were estimated from a cohort of 20 patients and 40 healthy female volunteers using the time trade-off technique. The outcomes were then generated through a decision-analytic model. First-line treatment costs with TP were approximately fourfold greater on a per-cycle basis than the CP alternative (Can$1911 vs Can$459). When progression-free survival benefit and patient treatment preferences were incorporated into the analysis, the results of the decision model revealed an incremental cost between Can$12,000 and Can$24,000 per quality-adjusted progression-free year with the TP protocol. Even though the TP combination has a considerably higher drug acquisition cost, the results of the current analysis suggest that this new chemotherapy regimen does provide patients with substantial quality-adjusted progression-free survival benefit at a reasonable cost to the Canadian health care system.

Adult↗
PubMed1997

A pilot study to evaluate the feasibility of using willingness to pay as a measure of value in cancer supportive care: an assessment of amifostine cytoprotection.

The most commonly used method for pharmacoeconomic studies has been the cost-effectiveness analysis (CEA), where the outcome is expressed as an incremental cost per unit of effectiveness (e.g. quality-adjusted life years). Although CEA is a valuable tool for identifying therapies that are more effective and less expensive, deficiencies develop when a given treatment is both more expensive and more effective. An alternative that has not been investigated in the oncology setting is the willingness-to-pay (WTP) method. In this pilot study, a WTP strategy was utilized to estimate the value that the Canadian tax-paying public puts on amifostine, a new cytoprotective agent that reduces the risk of chemotherapy-induced toxicity. The method of WTP was used within the framework of a classical cost-benefit analysis to estimate the net cost or benefit of prophylactic amifostine in patients with ovarian cancer who were receiving chemotherapy. This included direct costs for amifostine administration and hospital savings secondary to the reduced incidence of antineoplastic toxicity. A random sample of 50 Canadian tax-payers were interviewed to ascertain their maximum WTP for the new drug. The WTP survey instrument was simple to administer and easily understood by participants. Respondents stated that they would be willing to pay an average of $Can3,476 (95% confidence interval = $Can2,275 to $Can4,676) as an income tax increase to be paid over their lifetime for the value offered by the product. The benefit was then subtracted from the overall cost of amifostine ($Can3,826). This produced a net cost of $Can350 per patient (95% confidence interval = -$Can850 to $Can1,551), suggesting a situation of cost neutrality. WTP as a measure of value for oncology products is feasible and should be considered for future economic evaluations. The strategy is currently being used at this institution to determine the net societal cost or benefit of other cancer supportive care therapies, such as epoetin-alfa.

Adolescent↗
PubMed1997

Cost-benefit analysis of prophylactic granulocyte colony-stimulating factor during CHOP antineoplastic therapy for non-Hodgkin's lymphoma.

Several randomised comparative trials have shown that granulocyte colony-stimulating factor (G-CSF) reduces the duration of neutropenia, hospitalisation and intravenous antibacterial use in patients with cancer who are receiving high-dosage antineoplastic therapy. However, one area that has received less attention is the role of G-CSF in standard-dosage antineoplastic regimens. One such treatment that is considered to have a low potential for inducing fever and neutropenia is the CHOP regimen (cyclophosphamide, doxorubicin, vincristine and prednisone) for non-Hodgkin's lymphoma. We conducted a cost-benefit analysis from a societal perspective in order to estimate the net cost or benefit of prophylactic G-CSF in this patient population. This included direct costs for hospitalisation with antibacterial support, as well as indirect societal costs, such as time off work and antineoplastic therapy delays secondary to neutropenia. The findings were then tested by a comprehensive sensitivity analysis. The administration of G-CSF at a dosage of 5 micrograms/kg/day for 11 doses following CHOP resulted in an overall net cost of $Can1257. In the sensitivity analysis, lowering the G-CSF dosage to 2 micrograms/kg/day generated a net benefit of $Can6564, indicating a situation that was cost saving to society. The results of the current study suggest that the use of G-CSF in patients receiving CHOP antineoplastic therapy produces a situation that is close to achieving cost neutrality. However, low-dosage (2 micrograms/kg/day) G-CSF is an economically attractive treatment strategy because it may result in overall savings to society.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

A randomized trial of the effects of pharmacist intervention on the cost of antiemetic therapy with ondansetron.

Ondansetron has had a major impact on the prevention of emesis in patients receiving chemotherapy. However, the high cost and potential for inappropriate prescribing of this agent warranted a closer examination of its utilization. Hospital guidelines regarding the use of ondansetron were prepared by the Pharmacy and Therapeutics Committee and approved by the Medical Advisory Committee. The guidelines were then distributed to all physicians. Physicians were randomized into an intervention or non-intervention group. A prospective drug use evaluation was then conducted for a 10-week period where pharmacists monitored ondansetron prescribing and compared each order against hospital guidelines. For orders deemed inappropriate, only the intervention-group physicians were contacted for therapy modification. The control of nausea and vomiting was then assessed for all patients 24 h and 72 h after chemotherapy via a simple patient questionnaire. There were no significant differences with respect to the control of nausea and vomiting between patients who received ondansetron according to guidelines and those who did not. A total of 76% (48/63) of the prescriptions met hospital guidelines in the intervention group compared to 51.6% (33/64) in the control (P = 0.007). During the study period, physicians in the intervention group prescribed $Can 757 worth of ondansetron inappropriately compared to $1814 in the control. Drug use evaluation with pharmacist intervention was an effective method of controlling unnecessary hospital costs and contributed towards the appropriate use of ondansetron without compromising patient care.

Antineoplastic Agents↗
PubMed1995

Economic analyses of toxicity secondary to anthracycline-based breast cancer chemotherapy.

Doxorubicin (D) is one of the most active agents in the treatment of breast cancer but can be associated with cardiotoxicity (CT) and febrile neutropenia (FN). Epirubicin, a stereoisomer of doxorubicin, is reported to have similar efficacy but reduced toxicity. A retrospective chart audit was performed to estimate the incidence, average length of hospitalisation and resource consumption for the management of CT and FN in 200 patients breast cancer patients receiving equidoses of doxorubicin or epirubicin. Overall, there were three more episodes of CT in the doxorubicin group than in epirubicin patients (five versus two) at a cost of Canadian dollars C$4268/episode. With regard to FN, there were 11 more episodes in the doxorubicin arm (25 versus 14) at a cost of C$5419/episode. The results of the study support the substitution of equidose epirubicin for doxorubicin in women undergoing treatment for malignancies of the breast. Such a policy may result in reduced toxicity-related management costs.

Adult↗