Are the True Impacts of Adverse Events Considered in Economic Models of Antineoplastic Drugs? A Systematic Review
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Antineoplastic drugs for cancer are often associated with adverse events, which influence patients’ physical health, quality of life and survival. However, the modelling of adverse events in cost-effectiveness analyses of antineoplastic drugs has not been examined.
This article reviews published economic evaluations that include a calculated cost for adverse events of antineoplastic drugs. The aim is to identify how existing models manage four issues specific to antineoplastic drug adverse events: the selection of adverse events for inclusion in models, the influence of dose modifications on drug quantity and survival outcomes, the influence of adverse events on quality of life and the consideration of multiple simultaneous or recurring adverse events.
A systematic literature search was conducted using MESH headings and key words in multiple electronic databases, covering the years 1999–2009. Inclusion criteria for eligibility were papers covering a population of adults with solid tumour cancers, the inclusion of at least one adverse event and the resource use and/or costs of adverse event treatment.
From 4,985 citations, 26 eligible articles were identified. Studies were generally of moderate quality and addressed a range of cancers and treatment types. While the four issues specific to antineoplastic drug adverse events were addressed by some studies, no study addressed all of the issues in the same model.
This review indicates that current modelling assumptions may restrict our understanding of the true impact of adverse events on cost effectiveness of antineoplastic drugs. This understanding could be improved through consideration of the selection of adverse events, dose modifications, multiple events and quality of life in cost-effectiveness studies.
KeywordsEconomic Evaluation Febrile Neutropenia Dose Modification Antineoplastic Therapy Antineoplastic Drug
The authors would like to acknowledge the contribution of Liz Chinchen in conducting the literature search for this review.
Alison Pearce was supported by a University of Technology, Sydney Doctoral Scholarship, and a PhD top-up scholarship within an NHMRC Health Services Research Grant (ID455366) through the Centre for Health Economics Research and Evaluation; neither funding organisation had any role in the study.
Alison Pearce: Contributed to the planning of the study, designed the search strategy, conducted the literature searches, reviewed the retrieved articles for eligibility, completed and documented data extraction, and wrote the paper for publication. Alison Pearce is the guarantor for the overall content of the paper.
Marion Haas: Contributed to the planning of the study, advised on the design of the search strategy, reviewed the eligibility of articles where eligibility was uncertain, advised on data extraction and interpretation of results, and reviewed the publication.
Rosalie Viney: Contributed to the planning of the study, advised on the design of the search strategy, advised on data extraction and interpretation of results, and reviewed the publication
Liz Chinchen: Contributed to advising on search strategy techniques, conducted the literature searches and retrieved the eligible articles
Conflict of interest
All authors have declared no conflict of interest.
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