Cost-effectiveness of strain-targeted cardioprotection for prevention of chemotherapy-induced cardiotoxicity
Section snippets
Model design
This decision-analytic model evaluated the morbidity, mortality, and costs inherent in three clinically-relevant strategies; 1) the current standard strategy of initiating cardioprotection medications after diagnosis of EF-CTX (diagnosed as an asymptomatic decline in LVEF by > 10% to value of < 55%) or symptomatic heart failure, 2) a strategy of uniform cardioprotection (UCP) for all patients at the time of chemotherapy, and a 3) a strategy of using S-CTX (defined as a decline in global
Health outcomes and costs
In the reference case (49 year old woman taking anthracycline and trastuzumab for breast cancer, annual cost of cardioprotective medication of $81 with 56% probability of medication side-effects, leading to 38% overall abandoning cardioprotection), the outcomes of SGCP (3.79 ± 0.87 QALYs, $4159 ± $3997 over 5 years) were superior to those of UCP (3.64 ± 0.75 QALYs, $5967 ± $5840) and EFGCP (3.53 ± 0.86 QALYs, $7033 ± $6450). Both UCP and EFGCP were dominated by SGCP strategy.
Sensitivity analyses
One-way sensitivity analyses were
Discussion
In this analysis of the cost-effectiveness of three strategies for targeting cardioprotective medications for the prevention of chemotherapy-related cardiomyopathy, global longitudinal strain provided additional QALYs at lesser cost compared with UCP and LVGCP. SGCP also produced the highest value of 5-year survival, and was the optimal strategy in the majority of Monte Carlo simulations. The increased 5-year survival reflects the high mortality burden of heart failure, even small reductions in
Conflict of interest
No author has conflicts of interest. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Acknowledgement
Funded in part by a scholarship from National Heart Foundation, Canberra, Australia.
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