Author/Editor | Niraula, Saroj; Amir, Eitan; Vera-Badillo, Francisco Emilio; Šeruga, Boštjan; Ocaña, Alberto; Tannock, Ian | |
Title | Risk of incremental toxicities and associated costs of new anticancer drugs | |
Type | članek | |
Vol. and No. | Letnik 32, št. 32 | |
Publication year | 2014 | |
Volume | str. 3634-3642 | |
ISSN | 0732-183X - Journal of clinical oncology : official journal of the American Society of Clinical Oncology | |
Language | eng | |
Abstract | There are increasing reports of rare but serious toxicities caused by new anticancer drugs, and there are costs associated with their management. METHODS: We identified anticancer drugs approved by the U.S. Food and Drug Administration from 2000 to 2011 and pivotal trials supporting their registration. Twelve frequent grade 3 to 4 adverse event (AEs) were weighted and pooled in a meta-analysis. Estimates of incremental drug prices and incremental costs for management of AEs were calculated according to type of new agent based on target specificity. RESULTS: We identified 41 studies comprising 27,539 patients and evaluating 19 experimental drugs. Agents directed against a specific molecular target on cancer cells had a lower incidence of grade 3 to 4 toxicities compared with controls (median risk ratio [RR], 0.67; P = .22), whereas less-specific targeted agents, including angiogenesis inhibitors (median RR, 3.39; P < .001) and chemotherapeutic agents (median RR, 1.73; P < .001), were more toxic. Risk was increased regardless of whether the control arm contained active treatment (RR, 2.11; P < .001) or not (RR, 3.02; P < .001). Median incremental drug price for experimental agents was $6,000 per patient per month. Median cost of managing toxicity was low compared with drug costs but higher than controls for treatment with less-specific targeted agents and chemotherapies. CONCLUSION: Newly approved anticancer drugs are associated with increased toxicity, except for agents with a specific molecular target on cancer cells. Management of toxicity leads to a small increase in overall cost of treatment. Frequency of toxicity and associated costs are likely higher in less-selected patients treated in general oncologic practice. Development of biomarker-driven agents should be encouraged. | |
Keywords | kemoterapija toksičnost zdravil stroški zdravljenja onkološko zdravljenje |