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The challenge of conducting pharmacoeconomic evaluations in oncology using crossover trials: The example of sunitinib for gastrointestinal stromal tumour.

Author(s): Chabot I, Lelorier J, Blackstein ME

Affiliation(s): Department of Outcomes Research, Medical Division, Pfizer Canada Inc., 17300 Trans-Canada Highway, Kirkland, QC, Canada H9J 2M5.

Publication date & source: 2008-05, Eur J Cancer., 44(7):972-7. Epub 2008 Mar 26.

This paper examines the challenge of conducting economic evaluations to support patient access to cancer therapies when the cost-effectiveness estimation is hampered by crossover trial design. To demonstrate these limitations, we present the submission to the Canadian Drug Review (CDR) of a cost-effectiveness evaluation of sunitinib versus best supportive care (BSC) for the treatment of gastrointestinal stromal tumour in patients intolerant or resistant to imatinib. The economic model generated an incremental cost-effectiveness ratio for sunitinib versus BSC of $79,884/quality-adjusted life-year gained. Eight months after initial submission, CDR granted a final recommendation to fund sunitinib following the manufacturer's appeal against their first recommendation. Although cost-effectiveness is an important consideration in reimbursement decisions, there is a need for improved decision-making processes for cancer drugs, as well as a better understanding of the limitations of clinical trial design.

Page last updated: 2008-06-22

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