OPEN Education Programs

For Your Own PE Analysis

Breast cancer is the most prevalent form of cancer treated by your oncology department, with more than 600 new cases seen annually. Approximately two-thirds of patients present with local disease, but the remaining third either have metastatic disease at diagnosis or have recurred at distant sites after their initial therapy was completed. There are no drugs available that will cure this latter group of patients, but your department has had reasonable success with them using the hypothetical drug Infusium, which was approved in 2003 for treating colon cancer but has since been widely accepted as effective for breast cancer as well.

An internal review of patient records showed that 80 percent of patients treated with the drug in 2009 were still alive as of February 2011. The standard protocol is for the drug to be delivered in a 90-minute IV infusion once every 3 weeks for 6 cycles.

A new oral drug—Capsulium—was recently approved by the FDA based on a large clinical trial in which in which 65 percent of recurrent, metastatic breast cancer patients remained disease–free at 12 months compared to 40 percent of patients placed on best supportive care.

A physician advocate at your institution has argued that Capsulium should be considered as an alternative to Infusium for metastatic breast patients seen at your institution. The recommendation is based on a better adverse event profile for the new drug (none of the patients in the clinical trial experienced any nausea or vomiting) and the increased convenience offered by oral products.

Your oncology pharmacy is conducting its annual review in mid-September and has asked you to evaluate the relative merits of the new drug. Specifically, you have been asked to conduct a cost-utility analysis (CUA) and to present it at the upcoming meeting.

Part 1. Identify and Assemble the Relevant Information

(July 14 though August 10)

• Identify the relevant costs that would be included if the CUA (cost-utility analysis) adopted a payer perspective, a patient perspective, or the perspective of your center (for July 21 call-in).
• Relying on the evidence in the scenario, select a measure (or measures) of survival that you think fairly represents the drugs and that patients would find meaningful. List any assumptions that are implicit in the measure you select (for July 21 call-in).
• Describe how you would go about adjusting survival to account for the extent of emesis associated with each drug. Specifically, 1) conduct a search to identify any available evidence on patient utilities for avoiding nausea and vomiting, and 2) in light of that evidence and the information available in the case scenario, create a measure for emesis that you think is meaningful and practical (for July 28 call-in).
• List all the specific data items that would be needed to calculate the net cost of each drug to your center (for August 4 call-in).

Part 2. Build the Model and Interpret its Results

August 12 though September 14
Details Coming Soon

Note: An August 18 presentation will be held as a live web session rather than call-in and will be devoted to the basics of model-building using Excel, including how to create worksheets, enter data, and link cells.