Author + information
- Mark Nolan,
- Juan Carlos Plana,
- Paaladinesh Thavendiranathan and
- Thomas Marwick
Cardioprotective (CP) medications decrease the risk of developing chemotherapy-induced cardiotoxicity (CTX), but have associated side effects and additional cost. We sought the most cost-effective strategy for CP.
A Markov model was used to compare survival, quality-adjusted life-years (QALYs) and costs (calculated from a US healthcare perspective) for 3 strategies: LVEF-guided therapy (EFGT), uniform CP (UCP) or 2D strain echo guided therapy (SGT) over a 5 year horizon. We utilized our observations and the available literature to quantify associated risks, transition probabilities and costs. Sensitivity analyses were performed on all variables.
The 5-year cumulative costs and QALYs per patient for SGT, UCP and EFGT are listed in Table 1. Strain-guided CP showed incremental benefit over UCP, with incremental CE-ratio (ICER) of $4,138±$12,121 per QALY gained, and dominance over EFGT, with cost savings of $1236 and QALY savings of 0.23. Model results were stable over a wide range of all variables, but variations in the cost of cardioprotective medications and probabilities of cardioprotection side-effects had modest effect, with strain-guided cardioprotection dominating UCP at or above annual medication costs >$735 and side-effect costs >$1840.
2D-strain guided therapy in patients at risk of CTX provides more QALYs at lower cost than usual (EF-guided) therapy.
|Strategy||Cumulative Cost (US$)||Cumulative Effectiveness (QALYs)||ICER (US$/QALY)||Five-year survival|
|Uniform therapy||$13, 987 ±$15,522||3.70±0.80||-||79%|
|Strain-guided therapy||$14,318 ±$18,701||3.78±0.77||$4137||82%|
|LVEF-guided therapy||$15,554 +$17,020||3.55±0.82||Dominated||76%|
Poster Hall B1
Sunday, March 15, 2015, 9:45 a.m.-10:30 a.m.
Session Title: Non Invasive Imaging: Strain Imaging by Echocardiography
Abstract Category: 17. Non Invasive Imaging: Echo
Presentation Number: 1174-039
- 2015 American College of Cardiology Foundation