Disease specific methods for economic evaluations of breast cancer therapies

Abstract

Cost-effectiveness analyses (CEAs) are widely considered to be helpful tools for making informative decisions in a resource constrained environment. Since the introduction of economic evaluations in reimbursement submissions in Australia as a formal requirement in 1993, CEAs have become widespread with approximately half the countries in the European Union requesting economic data to varying degrees in their reimbursement decision process.

To ensure appropriate quality of CEAs, guidelines were developed and published several years ago, with the Drummond guideline in the British Medical Journal (BMJ) as the most widely applied one. Regardless of the implementation of these guidelines, several studies have shown that CEAs differ markedly in quality. As CEAs could have a direct effect on the reimbursement of therapies and patient access to medication is strongly related to reimbursement it is of utmost importance that analyses and outcomes are of high quality, robust, comparable, and credible.

In this thesis, we aimed to study whether current model based CEAs in early breast cancer have sufficient quality, whether modelling methods are comparable between published articles and whether they reflect “real world” disease progression. In addition we aimed to assess utility and real world observational costing data for metastatic breast cancer (MBC) in different countries. Research is presented on various subjects such as, reviewing early breast cancer CEAs, introducing new cost-effectiveness frameworks, quality of life in MBC and at last real world observational costing studies for MBC from patient population levels