The lowdown: Given the high financial costs of some recently approved cancer therapies and the cost-sensitivity of health-care systems worldwide, the issue of whether new cancer therapeutics offer additional cost-effectiveness benefits relative to those already in use is attracting increasing attention. Two recent studies published in Cancer, both partially funded by the respective manufacturers, have separately shown that the aromatase inhibitor Aromasin (exemestane; Pfizer) and Herceptin (trastuzumab; Genentech/Roche), an antibody against the human epidermal growth factor receptor 2 (HER2), are cost-effective for the treatment of breast cancer. In the first study, Risebrough and colleagues (Cancer 25 June 2007; doi:10.1002/cncr.22824) show that in postmenopausal women with primary breast cancer, switching to Aromasin therapy after 2 to 3 years of tamoxifen provides a cost-effectiveness ratio of Can$24,185 per quality-adjusted life-year (QALY) gained, well below the commonly accepted threshold of $50,000 per QALY in Canada. In the second study, Garrison Jr and colleagues (Cancer 25 June 2007; doi:10.1002/cncr.22806) calculated the projected lifetime cost of Herceptin therapy to be US$26,417 per QALY gained in patients with HER2-positive, operable, early breast cancer, a level below that of many treatments commonly used for patients with cancer.
Cost-effectiveness studies are increasingly being used to assess whether therapies should be reimbursed by health-care providers. On 9 July 2007, the UK National Institute of Health and Clinical Excellence (NICE) recommended Alimta (pemetrexed disodium; Eli Lilly) for the treatment of patients with advanced malignant pleural mesothelioma that cannot be treated surgically. This was a reversal of the 26 June 2006 decision that found that the drug was not cost-effective. NICE is currently being challenged in the UK High Court over its use of cost-effectiveness studies when generating treatment guidance for the treatment of Alzheimer's disease. A group of organizations led by Eisai, which markets the acetylcholinesterase inhibitor Aricept (donepezil hydrochloride) with Pfizer, are challenging NICE's guidance that recommends that acetylcholinesterase inhibitors should not be used for patients with mild dementia, in part owing to insufficient cost-effectiveness. The judicial review, which is the first of its kind, has been completed and a decision is expected on 10 August 2007.
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