TY - JOUR
T1 - An exploratory cost-effectiveness analysis of systemic treatments for cutaneous T-cell lymphoma
AU - Geskin, Larisa
AU - Malone, Daniel C.
N1 - Funding Information:
Financial support for this study and article was provided by Therakos, Inc., a Mallinckrodt Pharmaceuticals company, the manufacturer of ECP. The authors are grateful to Lisa E. Hines, PharmD, of Pharmaceutical Information Specialists, Scottsdale, Arizona for input on the study design, identification of the relevant studies, acquisition of cost data, analysis and interpretation of the data, and drafting the article, of as well as Vanita Sharma, PharmD, formerly of Therakos Inc., a Mallinckrodt Pharmaceuticals company, Bedminster, NJ, for publication organizational support.
Publisher Copyright:
© 2017, © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2018/7/4
Y1 - 2018/7/4
N2 - Purpose: To conduct an exploratory cost-effectiveness analysis of systemic treatment options for more advanced cutaneous T-cell lymphoma (CTCL). Methods: A cost-effectiveness model compared systemic bexarotene, denileukin diftitox, interferon-α, methotrexate, pralatrexate, romidepsin, vorinostat, and extracorporeal photopheresis (ECP) treatment of CTCL. Treatment effectiveness data were extracted from published studies and/or US product labeling. Overall response, the primary effectiveness measure, was defined as the proportion of patients achieving complete or partial response. Costs were based on wholesale acquisition cost (medications) and Medicare reimbursement rates (ECP, medication administration, adverse drug effect treatment). The perspective of the study was from that of a payer. Results: Methotrexate was the lowest cost option [mean $436; standard deviation (SD) $284], followed by interferon-α (mean $32,174; SD $27,582), denileukin difitox (mean $40,107; SD $18,598), and ECP (mean $40,985; SD $45,633). Other treatments had costs greater than $50,000, ranging from vorinostat ($65,958; SD $40,637) to bexarotene ($239,424; SD $178,881). The incremental cost-effectiveness ratio per successfully treated patient was $396,725 (interferon) and $213,416 (ECP). Denileukin diftitox, romidepsin, and vorinostat were less effective and cost more than methotrexate. Conclusion: Methotrexate is the most cost-effective option for CTCL; however, its low cost is offset by its limited effectiveness in advanced stages of CTCL. ECP and interferon appear the next most cost-effective therapies.
AB - Purpose: To conduct an exploratory cost-effectiveness analysis of systemic treatment options for more advanced cutaneous T-cell lymphoma (CTCL). Methods: A cost-effectiveness model compared systemic bexarotene, denileukin diftitox, interferon-α, methotrexate, pralatrexate, romidepsin, vorinostat, and extracorporeal photopheresis (ECP) treatment of CTCL. Treatment effectiveness data were extracted from published studies and/or US product labeling. Overall response, the primary effectiveness measure, was defined as the proportion of patients achieving complete or partial response. Costs were based on wholesale acquisition cost (medications) and Medicare reimbursement rates (ECP, medication administration, adverse drug effect treatment). The perspective of the study was from that of a payer. Results: Methotrexate was the lowest cost option [mean $436; standard deviation (SD) $284], followed by interferon-α (mean $32,174; SD $27,582), denileukin difitox (mean $40,107; SD $18,598), and ECP (mean $40,985; SD $45,633). Other treatments had costs greater than $50,000, ranging from vorinostat ($65,958; SD $40,637) to bexarotene ($239,424; SD $178,881). The incremental cost-effectiveness ratio per successfully treated patient was $396,725 (interferon) and $213,416 (ECP). Denileukin diftitox, romidepsin, and vorinostat were less effective and cost more than methotrexate. Conclusion: Methotrexate is the most cost-effective option for CTCL; however, its low cost is offset by its limited effectiveness in advanced stages of CTCL. ECP and interferon appear the next most cost-effective therapies.
KW - Cost-effectiveness
KW - cutaneous T-cell lymphoma
KW - extracorporeal photopheresis
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U2 - 10.1080/09546634.2017.1412064
DO - 10.1080/09546634.2017.1412064
M3 - Article
C2 - 29191068
AN - SCOPUS:85038396552
SN - 0954-6634
VL - 29
SP - 522
EP - 530
JO - Journal of Dermatological Treatment
JF - Journal of Dermatological Treatment
IS - 5
ER -