Transcript Drug Cost Avoidance Presentation

Estimation of drug cost avoidance (DCA) and
pathology cost avoidance (PCA) through
participation in NCIC clinical trials group phase III
trials
Patricia A. Tang, Annette E. Hay, Christopher J.
O’Callaghan, Nicole Mittmann, Carole Chambers,
Joseph L. Pater, Natasha B. Leighl
Background
• Cost avoidance occurs when trial
participation leads to provision of:
– drug therapy (drug cost avoidance- DCA)
– Pathology test (pathology cost avoidance –
PCA)
• Thus, 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
enrolled in NCIC-CTG phase III trials
Methods
• Phase III clinical trials that completed accrual and
resulted in DCA or PCA were identified (19992011)
• PCA was calculated based on the number of
patients screened and test cost
• DCA was estimated based on the number of
patients randomized, protocol dosing regimen,
drug cost, median dose intensity, and median
duration of therapy
– Historical prices were used if available
• CA for Canadian patients accrued are presented
in Canadian dollars with no adjustment for inflation
Results
• 4 trials lead to PCA
• 17 trials lead to DCA
• Excluded trials:
– 60 trials did not lead to PCA or DCA
– 36 trials: observation was the control
arm
– 2 trials: Canadian patients enrolled was
3 or less
Results – Pathology Cost
Avoidance
Trial
Pathology Number of
Test
tests
Cost of one
test ($)
Pathology
Cost
Avoidance ($)
CO20
KRAS
334
298
99,395
CRC3
MSI
62
300
18,600
CRC5
KRAS
140
298
41,663
MAC12
21 gene
recurrence
score
943
4279
4,035,191
Total Pathology Cost Avoidance: $4,194,849
Costs are rounded to nearest dollar
Results – Drug Cost Avoidance
Targeted Therapy
Trial
Trial design
(Drug supplied by
trial)
Drug with
cost
avoidance
Mean
DCA per
patient
($)
Total DCA for
trial ($)
CO20
Cetuximab
Cetuximab + brivanib
Cetuximab
22,588
7,544,519
CRC5
Chemo + bevacizumab
Chemo + cetuximab
Chemo + bev + Cetuximab
Bevacizumab
17,430
1,115,520
MA31
Taxane + trastuzumab
Taxane + lapatinib
Trastuzumab
31,784
1,239,595
REC1
Interferon α
Interferon α
Interferon α + bevacizumab
4,290
6,8643
LY12
Rituximab + DHAP
Rituximab + GDP
6,116
1,932,498
Rituximab
Total Targeted Therapy DCA = $11,900,775
Results – Drug Cost Avoidance
Trial
Trial design
Drug with
cost
avoidance
Mean
DCA per
patient
($)
Total DCA for
trial ($)
MA27
Anastrazole
Exemestane
Anastrazole
7,317
9,519,856
MAC1
CMF or AC
Capecitabine
CMF/AC
535
6,959
MAC4
Tamoxifen
Tamoxifen + OFS
Exemestane + OFS
Tamoxifen
447
21,000
MAC5
Tamoxifen + OFS
Exemestane + OFS
Tamoxifen
447
39,319
MAC7
Anastrazole
Anastrazole + Fulvestrant
Anastrazole
2,005
88,209
HN6
Cisplatin + RT
Panitumumab + RT
Cisplatin
90
14,391
BRC.3
Cisplatin + etoposide
Cisplatin +irinotecan
etoposide
1,106
4,423
Results – Drug Cost Avoidance
Trial
Trial design
Drug with
cost
avoidance
Mean
DCA per
patient
($)
Total DCA for
trial ($)
CO13
IFL
FOLFOX
IROX
Irinotecan
10,565
1,595,249
CRC2
FOLFOX
FOLFOX + cetuximab
Oxaliplatin
13,665
3,689,425
PA2
FUFA
Gemcitabine
FUFA
93
3,993
OV16
Carboplatin + paclitaxel x 8
Cisplatin+ topotecan x 4
then carbo/paclitaxel x 4
paclitaxel
3,011
710,586
OV17
Carboplatin + paclitaxel x6
Carboplatin + PLD x6
paclitaxel
4,996
169,858
LY12
Rituximab + DHAP
Rituximab + GDP
Cytarabine
1,088
171,914
Drug cost avoidance across trials
35,000
31,784
25,000
22,588
20,000
15,000
13,665
10,565
9,034
10,000
6,660
4,996
4,290
5,000
639
10.07.03
93
535
639
10.07.03
3,011
2,005
1,106
1,743
90
03.03.08
02.05.08
17.07.08
18.12.08
05.12.04
22.09.04
MAC4 MAC5 REC1 CRC2 BRC3
Trial Name and Activation Date
23.01.06
LY12
17.10.05
MAC1 MA.27
23.04.04
PA2
08.07.03
OV16
06.02.03
31.10.01
CO13
28.05.02
31.08.01
0
16.11.99
Drug Cost Avoidance Per Patient ($)
30,000
OV17
MAC7
CRC5
CO20
MA31
HN6
Results
• Across 17 trials, total drug cost
savings estimated at $27,935,957
– $8,744 DCA per patient
– 42% Targeted therapy: $11,900,775 (5
trials)
• Combined pathology and drug cost
avoidance: $32,130,806
Limitations
• Drug wastage, expired drug lots, published prices
• Regional differences in the ‘payer’: patient versus
provincial health care system versus private
insurance
• Some pathology tests may have been done as
part of standard of care, prior to enrollment in the
trial
• For some situations, there is more than one
‘standard’ eg. Tam-AI switch
• Utilized drug administration data, did not account
for patient non-adherence
Conclusions
• Over the time period studied, these
NCIC-CTG trials resulted in total cost
avoidance (pathology plus drug) of
approximately $7514 per patient
• Not all trials lead to cost avoidance
• These savings should be accounted
for when considering the financial
impact of clinical research
Discussion
• This study did not incorporate the
incremental patient care costs associated
with clinical trial participation
• Liniker et al evaluated treatment cost
difference for standard patient care
compared to participation in industry
as well as non-industry cancer trials 1
• An overall treatment cost saving of
£388 719 in 2009 and £496 556 in
2010 was observed, largely
attributable to DCA
1
British journal of cancer. 2013;109(8):2051-7.