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Published in: BMC Cancer 1/2019

Open Access 01-12-2019 | Cetuximab | Technical advance

Advantages of the net benefit regression framework for trial-based economic evaluations of cancer treatments: an example from the Canadian Cancer Trials Group CO.17 trial

Authors: Jeffrey S. Hoch, Annette Hay, Wanrudee Isaranuwatchai, Kednapa Thavorn, Natasha B. Leighl, Dongsheng Tu, Logan Trenaman, Carolyn S. Dewa, Chris O’Callaghan, Joseph Pater, Derek Jonker, Bingshu E. Chen, Nicole Mittmann

Published in: BMC Cancer | Issue 1/2019

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Abstract

Background

Economic evaluations commonly accompany trials of new treatments or interventions; however, regression methods and their corresponding advantages for the analysis of cost-effectiveness data are not widely appreciated.

Methods

To illustrate regression-based economic evaluation, we review a cost-effectiveness analysis conducted by the Canadian Cancer Trials Group’s Committee on Economic Analysis and implement net benefit regression.

Results

Net benefit regression offers a simple option for cost-effectiveness analyses of person-level data. By placing economic evaluation in a regression framework, regression-based techniques can facilitate the analysis and provide simple solutions to commonly encountered challenges (e.g., the need to adjust for potential confounders, identify key patient subgroups, and/or summarize “challenging” findings, like when a more effective regimen has the potential to be cost-saving).

Conclusions

Economic evaluations of patient-level data (e.g., from a clinical trial) can use net benefit regression to facilitate analysis and enhance results.
Literature
1.
go back to reference Fojo T, Grady C. How much is life worth: cetuximab, non-small cell lung cancer, and the $440 billion question. J Natl Cancer Inst. 2009;101(15):1044–8.CrossRef Fojo T, Grady C. How much is life worth: cetuximab, non-small cell lung cancer, and the $440 billion question. J Natl Cancer Inst. 2009;101(15):1044–8.CrossRef
2.
go back to reference Hoch JS, Sabharwal M. Informing Canada's cancer drug funding decisions with scientific evidence and patient perspectives: the Pan-Canadian oncology drug review. Curr Oncol. 2013;20(2):121–4.CrossRef Hoch JS, Sabharwal M. Informing Canada's cancer drug funding decisions with scientific evidence and patient perspectives: the Pan-Canadian oncology drug review. Curr Oncol. 2013;20(2):121–4.CrossRef
3.
go back to reference Thavorn K, Coyle D, Hoch JS, Vandermeer L, Mazzarello S, Wang Z, Dranitsaris G, Fergusson D. Clemons M. a cost-utility analysis of risk model-guided versus physician's choice antiemetic prophylaxis in patients receiving chemotherapy for early-stage breast cancer: a net benefit regression approach. Support Care Cancer. 2017. Thavorn K, Coyle D, Hoch JS, Vandermeer L, Mazzarello S, Wang Z, Dranitsaris G, Fergusson D. Clemons M. a cost-utility analysis of risk model-guided versus physician's choice antiemetic prophylaxis in patients receiving chemotherapy for early-stage breast cancer: a net benefit regression approach. Support Care Cancer. 2017.
4.
go back to reference Lairson DR, Dicarlo M, Deshmuk AA, Fagan HB, Sifri R, Katurakes N, Cocroft J, Sendecki J, Swan H, Vernon SW, Myers RE. Cost-effectiveness of a standard intervention versus a navigated intervention on colorectal cancer screening use in primary care. Cancer. 2014;120(7):1042–9.CrossRef Lairson DR, Dicarlo M, Deshmuk AA, Fagan HB, Sifri R, Katurakes N, Cocroft J, Sendecki J, Swan H, Vernon SW, Myers RE. Cost-effectiveness of a standard intervention versus a navigated intervention on colorectal cancer screening use in primary care. Cancer. 2014;120(7):1042–9.CrossRef
5.
go back to reference Shih YC, Pan IW, Tsai YW. Information technology facilitates cost-effectiveness analysis in developing countries: an observational study of breast cancer chemotherapy in Taiwan. Pharmacoeconomics. 2009;27(11):947–61.CrossRef Shih YC, Pan IW, Tsai YW. Information technology facilitates cost-effectiveness analysis in developing countries: an observational study of breast cancer chemotherapy in Taiwan. Pharmacoeconomics. 2009;27(11):947–61.CrossRef
6.
go back to reference Mittmann N, Au HJ, Tu D, O'Callaghan CJ, Isogai PK, Karapetis CS, Zalcberg JR, Evans WK, Moore MJ, Siddiqui J, Findlay B, Colwell B, Simes J, Gibbs P, Links M, Tebbutt NC, Jonker DJ. Working group on economic analysis of National Cancer Institute of Canada clinical trials group.; Australasian gastrointestinal interest group. Prospective cost-effectiveness analysis of cetuximab in metastatic colorectal cancer: evaluation of National Cancer Institute of Canada clinical trials group CO.17 trial. J Natl Cancer Inst. 2009;101(17):1182–92.CrossRef Mittmann N, Au HJ, Tu D, O'Callaghan CJ, Isogai PK, Karapetis CS, Zalcberg JR, Evans WK, Moore MJ, Siddiqui J, Findlay B, Colwell B, Simes J, Gibbs P, Links M, Tebbutt NC, Jonker DJ. Working group on economic analysis of National Cancer Institute of Canada clinical trials group.; Australasian gastrointestinal interest group. Prospective cost-effectiveness analysis of cetuximab in metastatic colorectal cancer: evaluation of National Cancer Institute of Canada clinical trials group CO.17 trial. J Natl Cancer Inst. 2009;101(17):1182–92.CrossRef
7.
go back to reference Jonker DJ, O'Callaghan CJ, Karapetis CS, Zalcberg JR, Tu D, Au HJ, Berry SR, Krahn M, Price T, Simes RJ, Tebbutt NC, van Hazel G, Wierzbicki R, Langer C, Moore MJ. Cetuximab for the treatment of colorectal cancer. N Engl J Med. 2007 Nov 15;357(20):2040–8.CrossRef Jonker DJ, O'Callaghan CJ, Karapetis CS, Zalcberg JR, Tu D, Au HJ, Berry SR, Krahn M, Price T, Simes RJ, Tebbutt NC, van Hazel G, Wierzbicki R, Langer C, Moore MJ. Cetuximab for the treatment of colorectal cancer. N Engl J Med. 2007 Nov 15;357(20):2040–8.CrossRef
8.
go back to reference Karapetis CS, Khambata-Ford S, Jonker DJ, O'Callaghan CJ, Tu D, Tebbutt NC, Simes RJ, Chalchal H, Shapiro JD, Robitaille S, Price TJ, Shepherd L, Au HJ, Langer C, Moore MJ, Zalcberg JR. K-ras mutations and benefit from cetuximab in advanced colorectal cancer. N Engl J Med. 2008;359(17):1757–65.CrossRef Karapetis CS, Khambata-Ford S, Jonker DJ, O'Callaghan CJ, Tu D, Tebbutt NC, Simes RJ, Chalchal H, Shapiro JD, Robitaille S, Price TJ, Shepherd L, Au HJ, Langer C, Moore MJ, Zalcberg JR. K-ras mutations and benefit from cetuximab in advanced colorectal cancer. N Engl J Med. 2008;359(17):1757–65.CrossRef
9.
go back to reference Rocchi A, Menon D, Verma S, Miller E. The role of economic evidence in Canadian oncology reimbursement decision-making: to lambda and beyond. Value Health. 2008;11(4):771–83.CrossRef Rocchi A, Menon D, Verma S, Miller E. The role of economic evidence in Canadian oncology reimbursement decision-making: to lambda and beyond. Value Health. 2008;11(4):771–83.CrossRef
10.
go back to reference Eichler HG, Kong SX, Gerth WC, Mavros P, Jonsson B. Use of cost-effectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge? Value Health. 2004;7(5):518–28.CrossRef Eichler HG, Kong SX, Gerth WC, Mavros P, Jonsson B. Use of cost-effectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge? Value Health. 2004;7(5):518–28.CrossRef
11.
go back to reference Rawlins MD, Culyer AJ. National Institute for clinical excellence and its value judgments. BMJ. 2004;329(7459):224–7.CrossRef Rawlins MD, Culyer AJ. National Institute for clinical excellence and its value judgments. BMJ. 2004;329(7459):224–7.CrossRef
12.
go back to reference Dakin H, Devlin N, Feng Y, Rice N, O'Neill P, Parkin D. The influence of cost-effectiveness and other factors on nice decisions. Health Econ. 2015;24:1256–71.CrossRef Dakin H, Devlin N, Feng Y, Rice N, O'Neill P, Parkin D. The influence of cost-effectiveness and other factors on nice decisions. Health Econ. 2015;24:1256–71.CrossRef
13.
go back to reference Ismail Z, Peacock SJ, Kovacic L, Hoch JS. Cost-effectiveness impacts cancer care funding decisions in British Columbia, Canada, evidence from 1998 to. Int J Technol Assess Health Care. 2008;5:1–6, 2017. Ismail Z, Peacock SJ, Kovacic L, Hoch JS. Cost-effectiveness impacts cancer care funding decisions in British Columbia, Canada, evidence from 1998 to. Int J Technol Assess Health Care. 2008;5:1–6, 2017.
14.
go back to reference Hoch JS, Dewa CS. Advantages of the net benefit regression framework for economic evaluations of interventions in the workplace: a case study of the cost-effectiveness of a collaborative mental health care program for people receiving short-term disability benefits for psychiatric disorders. J Occup Environ Med. 2014;56(4):441–5.CrossRef Hoch JS, Dewa CS. Advantages of the net benefit regression framework for economic evaluations of interventions in the workplace: a case study of the cost-effectiveness of a collaborative mental health care program for people receiving short-term disability benefits for psychiatric disorders. J Occup Environ Med. 2014;56(4):441–5.CrossRef
15.
go back to reference Hoch JS, Dewa CS. Lessons from trial-based cost-effectiveness analyses of mental health interventions: why uncertainty about the outcome, estimate and willingness to pay matters. Pharmacoeconomics. 2007;25(10):807–16.CrossRef Hoch JS, Dewa CS. Lessons from trial-based cost-effectiveness analyses of mental health interventions: why uncertainty about the outcome, estimate and willingness to pay matters. Pharmacoeconomics. 2007;25(10):807–16.CrossRef
16.
go back to reference Hoch JS. Net benefit regression. In M. Kattan (editor), encyclopedia of. Med Decis Mak. 2009;2:805–11. Hoch JS. Net benefit regression. In M. Kattan (editor), encyclopedia of. Med Decis Mak. 2009;2:805–11.
17.
go back to reference Hoch JS, Briggs AH, Willan AR. Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost-effectiveness analysis. Health Econ. 2002;11(5):415–30.CrossRef Hoch JS, Briggs AH, Willan AR. Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost-effectiveness analysis. Health Econ. 2002;11(5):415–30.CrossRef
18.
go back to reference O’Brien BJ, Drummond MF, Labelle RJ, Willan A. In search of power and significance: issues in the design and analysis of stochastic cost-effectiveness studies in health care. Med Care. 1994;32:150–63.CrossRef O’Brien BJ, Drummond MF, Labelle RJ, Willan A. In search of power and significance: issues in the design and analysis of stochastic cost-effectiveness studies in health care. Med Care. 1994;32:150–63.CrossRef
19.
go back to reference Nixon RM, Wonderling D, Grieve RD. Non-parametric methods for cost-effectiveness analysis: the central limit theorem and the bootstrap compared. Health Econ. 2010;19(3):316–33.CrossRef Nixon RM, Wonderling D, Grieve RD. Non-parametric methods for cost-effectiveness analysis: the central limit theorem and the bootstrap compared. Health Econ. 2010;19(3):316–33.CrossRef
20.
go back to reference Hoch JS, Rockx MA, Krahn AD. Using the net benefit regression framework to construct cost-effectiveness acceptability curves: an example using data from a trial of external loop recorders versus Holter monitoring for ambulatory monitoring of “community acquired” syncope. BMC Health Serv Res. 2006;6:68.CrossRef Hoch JS, Rockx MA, Krahn AD. Using the net benefit regression framework to construct cost-effectiveness acceptability curves: an example using data from a trial of external loop recorders versus Holter monitoring for ambulatory monitoring of “community acquired” syncope. BMC Health Serv Res. 2006;6:68.CrossRef
21.
go back to reference Stinnett AA, Mullahy J. Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analysis. Med Decis Mak. 1998 Apr-Jun;18(2 Suppl):S68–80.CrossRef Stinnett AA, Mullahy J. Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analysis. Med Decis Mak. 1998 Apr-Jun;18(2 Suppl):S68–80.CrossRef
22.
go back to reference Bang H, Tsiatis AA. Estimating medical costs with censored data. Biometrika. 2000;87:329–43.CrossRef Bang H, Tsiatis AA. Estimating medical costs with censored data. Biometrika. 2000;87:329–43.CrossRef
23.
go back to reference Chen S, Rolfes J, Zhao H. Estimation of mean health care costs and incremental cost-effectiveness ratios with possibly censored data. Stata J. 2015;15(3):698–711.CrossRef Chen S, Rolfes J, Zhao H. Estimation of mean health care costs and incremental cost-effectiveness ratios with possibly censored data. Stata J. 2015;15(3):698–711.CrossRef
24.
go back to reference Hoch JS, Chaussé P. Econometric considerations when using the net benefit regression framework to conduct cost-effectiveness analysis. B. Baltagi and F. Moscone (editors), health econometrics in contributions to economic analysis: Emerald Publishing; 2018. Hoch JS, Chaussé P. Econometric considerations when using the net benefit regression framework to conduct cost-effectiveness analysis. B. Baltagi and F. Moscone (editors), health econometrics in contributions to economic analysis: Emerald Publishing; 2018.
Metadata
Title
Advantages of the net benefit regression framework for trial-based economic evaluations of cancer treatments: an example from the Canadian Cancer Trials Group CO.17 trial
Authors
Jeffrey S. Hoch
Annette Hay
Wanrudee Isaranuwatchai
Kednapa Thavorn
Natasha B. Leighl
Dongsheng Tu
Logan Trenaman
Carolyn S. Dewa
Chris O’Callaghan
Joseph Pater
Derek Jonker
Bingshu E. Chen
Nicole Mittmann
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Cetuximab
Published in
BMC Cancer / Issue 1/2019
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-019-5779-x

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