Nolan, MT and Plana, JC and Thavendiranathan, P and Shaw, L and Si, L and Marwick, TH, Cost-effectiveness of strain-targeted cardioprotection for prevention of chemotherapy-induced cardiotoxicity, International Journal of Cardiology, 212 pp. 336-345. ISSN 0167-5273 (2016) [Refereed Article]
Copyright 2016 Elsevier Ireland Ltd.
METHODS: Three cardioprotection strategies were assessed: 1) usual care (EF-guided cardioprotection, EFGCP) with cardioprotection initiated on diagnosis of LVEF-defined cardiotoxicity (EF-CTX), 2) universal cardioprotection (UCP) for all such patients, and 3) strain-guided cardioprotection (SGCP - treatment of patients with subclinical cardiotoxicity [S-CTX]). A Markov model, informed by the published literature on transitional probabilities, costs and quality-adjusted life years (QALYs) was developed to assess the incremental cost-effectiveness ratio (ICER). Costs, effects and ICER of each specified cardioprotective strategy were assessed over a 5-year range, with sensitivity analyses for significant variables.
RESULTS: In the reference case of a 49 year old woman with stage IIb breast cancer treated with sequential anthracyclines and trastuzumab, strain-guided cardioprotection (3.79 QALYS and $4159 cost over 5years) dominated both UCP (3.64 QALYs and $5967 cost over 5years) and EFGCP (3.53 QALYs and $7033 cost over five years). Model results were dependent on the probabilities of patients developing subclinical LV dysfunction, with UCP dominating alternative strategies at probabilities ≥51%. Variations in the cost of cardioprotective medications and probabilities of cardioprotection side-effects had no effect on model conclusions.
CONCLUSIONS: In patients at risk of chemotherapy-related cardiotoxicity, strain-guided cardioprotection provides more QALYs at lower cost than standard care or uniform cardioprotection.
|Item Type:||Refereed Article|
|Keywords:||chemotherapy, cardiotoxicity, decision-making, cost effectiveness|
|Research Division:||Medical and Health Sciences|
|Research Group:||Cardiorespiratory Medicine and Haematology|
|Research Field:||Cardiology (incl. Cardiovascular Diseases)|
|Objective Group:||Clinical Health (Organs, Diseases and Abnormal Conditions)|
|Objective Field:||Cardiovascular System and Diseases|
|Author:||Nolan, MT (Mr Mark Nolan)|
|Author:||Si, L (Mr Lei Si)|
|Author:||Marwick, TH (Professor Tom Marwick)|
|Web of Science® Times Cited:||8|
|Deposited By:||Menzies Institute for Medical Research|
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