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Cost-effectiveness of strain-targeted cardioprotection for prevention of chemotherapy-induced cardiotoxicity
Mark T Nolan1, Juan Carlos Plana2, Paaladinesh Thavendiranathan3
1Menzies Institute for Medical Research, Hobart, Australia.
Insights
Strain-guided cardioprotection offers better outcomes and lower costs for patients undergoing cancer chemotherapy, outperforming usual care and universal cardioprotection strategies. This approach effectively manages chemotherapy-induced heart failure risk.
Area of Science:
- Cardiology
- Oncology
- Health Economics
Background:
- Cancer chemotherapy significantly elevates the risk of developing heart failure.
- Cardiotoxicity is a major concern in cancer treatment, impacting patient outcomes.
- Cost-effectiveness of cardioprotective strategies is crucial for healthcare providers.
Purpose of the Study:
- To compare the cost-effectiveness of strain-guided cardioprotection (SGCP) against usual care (EF-guided cardioprotection, EFGCP) and universal cardioprotection (UCP).
- To evaluate these strategies from a healthcare payer perspective over a five-year period.
- To determine the optimal strategy for preventing chemotherapy-induced cardiotoxicity.
Main Methods:
- A Markov model was utilized to assess three cardioprotection strategies: EFGCP, UCP, and SGCP.
- The model incorporated published data on transitional probabilities, costs, and quality-adjusted life years (QALYs).
- Incremental cost-effectiveness ratios (ICERs) were calculated, with sensitivity analyses performed on key variables.
Main Results:
- SGCP yielded superior outcomes (3.79 QALYs) at a lower cost ($4159) compared to UCP (3.64 QALYs, $5967) and EFGCP (3.53 QALYs, $7033) in the reference case.
- Universal cardioprotection (UCP) became dominant when the probability of subclinical left ventricular dysfunction reached 51% or higher.
- The cost of cardioprotective medications and side-effect probabilities did not influence the model's conclusions.
Conclusions:
- Strain-guided cardioprotection is a more cost-effective strategy for managing patients at risk of chemotherapy-related cardiotoxicity.
- SGCP provides greater quality-adjusted life years (QALYs) at a reduced cost compared to standard and uniform approaches.
- This highlights the value of early detection of subclinical cardiotoxicity for optimizing patient care and resource allocation.
Background:
Cancer chemotherapy increases the risk of heart failure. This cost-effectiveness model compared strain-guided cardioprotection with other protective strategies using a health care payer perspective and five-year time horizon.
Methods:
Three cardioprotection strategies were assessed: 1) usual care (EF-guided cardioprotection, EFGCP) with cardioprotection initiated on diagnosis of LVEF-defined cardiotoxicity (EF-CTX), 2) universal cardioprotection (UCP) for all such patients, and 3) strain-guided cardioprotection (SGCP - treatment of patients with subclinical cardiotoxicity [S-CTX]). A Markov model, informed by the published literature on transitional probabilities, costs and quality-adjusted life years (QALYs) was developed to assess the incremental cost-effectiveness ratio (ICER). Costs, effects and ICER of each specified cardioprotective strategy were assessed over a 5-year range, with sensitivity analyses for significant variables.
Results:
In the reference case of a 49year old woman with stage IIb breast cancer treated with sequential anthracyclines and trastuzumab, strain-guided cardioprotection (3.79 QALYS and $4159 cost over 5years) dominated both UCP (3.64 QALYs and $5967 cost over 5years) and EFGCP (3.53 QALYs and $7033 cost over five years). Model results were dependent on the probabilities of patients developing subclinical LV dysfunction, with UCP dominating alternative strategies at probabilities ≥51%. Variations in the cost of cardioprotective medications and probabilities of cardioprotection side-effects had no effect on model conclusions.
Conclusions:
In patients at risk of chemotherapy-related cardiotoxicity, strain-guided cardioprotection provides more QALYs at lower cost than standard care or uniform cardioprotection.
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