Minimization of resource utilization data collected within cost-effectiveness analyses conducted alongside Canadian Cancer Trials Group phase III trials

Matthew C Cheung; Kelvin Kw Chan; Shane Golden; Annette Hay; Joseph Pater; Anca Prica; Bingshu E Chen; Natasha Leighl; Nicole Mittmann

doi:10.1177/17407745211005045

Minimization of resource utilization data collected within cost-effectiveness analyses conducted alongside Canadian Cancer Trials Group phase III trials

Clin Trials. 2021 Aug;18(4):500-504. doi: 10.1177/17407745211005045. Epub 2021 Apr 19.

Authors

Matthew C Cheung^{1

2

3}, Kelvin Kw Chan^{1

2}, Shane Golden⁴, Annette Hay², Joseph Pater⁴, Anca Prica⁵, Bingshu E Chen⁴, Natasha Leighl⁵, Nicole Mittmann^{2

6}

Affiliations

¹ Division of Hematology, Department of Medicine, Odette Cancer Centre and University of Toronto, Toronto, ON, Canada.
² Committee on Economic Analysis, Canadian Cancer Trials Group, Queens University, Kingston, ON, Canada.
³ Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁴ Canadian Cancer Trials Group, Queens University, Kingston, ON, Canada.
⁵ Division of Hematology, Department of Medicine, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada.
⁶ Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.

Abstract

Background: Cost-effectiveness analyses embedded within randomized trials allow for evaluation of value alongside conventional efficacy outcomes; however, collection of resource utilization data can require considerable trial resources.

Methods: We re-analyzed the results from four phase III Canadian Cancer Trials Group trials that embedded cost-effectiveness analyses to determine the impact of minimizing potential cost categories on the incremental cost-effectiveness ratios. For each trial, we disaggregated total costs into component incremental cost categories and recalculated incremental cost-effectiveness ratios using (1) only the top 3 cost categories, (2) the top 5 cost categories, and (3) all cost components. Using individual trial-level data, confidence intervals for each incremental cost-effectiveness ratio simulation were generated by bootstrapping and descriptively presented with the original confidence intervals (and incremental cost-effectiveness ratios) from the publications.

Results: Drug acquisition costs represented the highest incremental cost category in three trials, while hospitalization costs represented the other consistent cost driver and the top incremental cost category in the fourth trial. Recalculated incremental cost-effectiveness ratios based on fewer cost components (top 3 and top 5) did not differ meaningfully from the original published results. Based on conventional willingness-to-pay thresholds (US$50,000-US$100,000 per quality-adjusted life-year), none of the re-analyses would have changed the original perception of whether the experimental therapies were considered cost-effective.

Conclusions: These results suggest that the collection of resource utilization data within cancer trials could be narrowed. Omission of certain cost categories that have minimal impact on incremental cost-effectiveness ratio, such as routine laboratory investigations, could reduce the costs and undue burden associated with the collection of data required for cancer trial cost-effectiveness analyses.

Keywords: Cancer clinical trials; economic evaluations; incremental cost-effectiveness ratios; phase III trials; resource utilization data.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Canada
Clinical Trials, Phase III as Topic*
Cost-Benefit Analysis*
Data Collection
Humans
Neoplasms* / drug therapy
Quality-Adjusted Life Years

Grants and funding

U10 CA180863/CA/NCI NIH HHS/United States