Abstract：
INTRODUCTION:The management of advanced gastrointestinal stromal tumors (GISTs) has been modified considerably by the availability of costly tyrosine kinase inhibitors (TKIs); however, the best therapeutic sequence in terms of cost and effectiveness remains unknown. OBJECTIVE:The aim of this study was to compare four potential strategies (reflecting the potential daily practice), each including imatinib 400 mg/day, as first-line treatment: S1 (imatinib400/best supportive care [BSC]); S2 (imatinib400/imatinib800/BSC); S3 (imatinib400/sunitinib/BSC); and S4 (imatinib400/imatinib800/sunitinib/BSC). METHODS:A Markov model was developed with a hypothetical cohort of patients and a lifetime horizon. Transition probabilities were estimated from the results of clinical trials. The analysis was performed from the French payer perspective, and only direct medical costs were included. Clinical and economic parameters were discounted, and the robustness of results was assessed. RESULTS:The least costly and effective strategy was S1, at a cost of €65,744 for 32.9 life months (reference). S3 was the most cost-effective strategy, with an incremental cost-effectiveness ratio (ICER) of €48,277/life-year saved (LYS). S2 was dominated, and S4 yielded an ICER of €363,320/LYS compared with S3. Sensitivity analyses confirmed the robustness of these results; however, when taking into account a price reduction of 80 % for imatinib, S2 and S4 become the most cost-effective strategies. CONCLUSION:Our approach is innovative to the extent that our analysis takes into account the sequential application of TKIs. The results suggest that the S1 strategy is the best cost-effective strategy, but a price reduction of imatinib impacts on the results. This approach must continue, including new drugs and their impact on the quality of life of patients with advanced GISTs.
journal_name
Clin Drug Investigjournal_title
Clinical drug investigationauthors
Nerich V,Fleck C,Chaigneau L,Isambert N,Borg C,Kalbacher E,Jary M,Simon P,Pivot X,Blay JY,Limat Sdoi
10.1007/s40261-016-0463-2subject
Has Abstractpub_date
2017-01-01 00:00:00pages
85-94issue
1eissn
1173-2563issn
1179-1918pii
10.1007/s40261-016-0463-2journal_volume
37pub_type
杂志文章abstract：OBJECTIVE:To compare the real-life treatment of acute exacerbations of chronic bronchitis (AECBs) using moxifloxacin tablets or one of the oral macrolides azithromycin, clarithromycin or roxithromycin in terms of symptom relief, time until improvement and cure, overall efficacy and tolerability. METHODS:This prospecti...
journal_title：Clinical drug investigation
pub_type： 杂志文章,多中心研究
doi：10.2165/00044011-200626120-00007
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abstract：BACKGROUND AND OBJECTIVE:There is a general concern about the use of multisource (generic) antibacterials in the clinical setting with registration based solely on bioequivalence data. In order to address this concern, two modified-release formulations of clarithromycin (i.e. the originator Klacid XL and the generic Kl...
journal_title：Clinical drug investigation
pub_type： 杂志文章,多中心研究,随机对照试验
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abstract：BACKGROUND:Epidemiological studies and clinical trials have shown that prevention of cardiovascular disease, the ultimate goal of hypertension treatment, requires a sufficient reduction in blood pressure. OBJECTIVE:The primary objective of this study was to compare the mean decrease in systolic (SBP) and diastolic (DB...
journal_title：Clinical drug investigation
pub_type： 杂志文章,多中心研究,随机对照试验
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pub_type： 杂志文章,多中心研究,随机对照试验
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pub_type： 杂志文章,多中心研究,随机对照试验
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pub_type： 杂志文章,meta分析
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pub_type： 杂志文章,meta分析,评审
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pub_type： 杂志文章
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更新日期：1998-01-01 00:00:00
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更新日期：2016-11-01 00:00:00
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pub_type： 杂志文章,收录出版,评审
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更新日期：2015-04-01 00:00:00
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journal_title：Clinical drug investigation
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pub_type： 杂志文章
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更新日期：2003-01-01 00:00:00
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pub_type： 杂志文章,随机对照试验
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更新日期：2013-12-01 00:00:00
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更新日期：2017-04-01 00:00:00
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更新日期：2012-01-01 00:00:00
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更新日期：2013-02-01 00:00:00
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journal_title：Clinical drug investigation
pub_type： 杂志文章
doi：10.2165/00044011-199815050-00009
更新日期：1998-01-01 00:00:00
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更新日期：2015-02-01 00:00:00
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更新日期：2021-01-01 00:00:00
