This study evaluated the cost utility of adding interferon-α2b to conventional treatment in patients with multiple myeloma. It also provides a methodology for transforming complex quality-of-life profiles into a single index value on the conventional 0 to 1 quality-adjusted life-year scale (QALY).
From 1990 to 1992,583 patients with newly diagnosed, symptomatic multiple myeloma were enrolled in a randomised, multicentre, phase III study to evaluate the addition of interferon-α2b to treatment with melphalan and prednisone.
Addition of interferon-α2b yielded a 12% increase in median survival time, at the expense of a slight reduction in quality of life during the first year of treatment. The gain in survival time was not large enough to reach statistical significance. Patients receiving interferon-α2b also had a 5- to 6-month prolongation of the plateau phase.
Cost per QALY gained by adding interferon-α2b was conservatively estimated at $US110 000. Potentially better cost effectiveness may be found in different treatment regimens or in certain patient subgroups.
Melphalan Multiple Myeloma Prednisone Health Profile Plateau Phase
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Kyle RA, Bayrd ED. The monoclonal gammopathies: multiple myeloma and related cell disorders. Springfield: Charles C. Thomas, 1976Google Scholar
Turesson I, Zettervalll O, Cuzick J, et al. Comparison of trends in the incidence of multiple myeloma in Malm0, Sweden and other countries. N Engl J Med 1984; 310: 421–4PubMedCrossRefGoogle Scholar
Wisløff F, Andersen P, Andersson TR, et al. Has the incidence of multiple myeloma in old age been underestimated? Eur J Haematol 1991; 47: 333–7PubMedCrossRefGoogle Scholar
Gregory WM, Richards MA, Malpas JS. Combination chemotherapy versus melphalan and prednisolone in the treatment of multiple myeloma: an overview of published trials. J Clin Oncol 1992; 10: 334–42PubMedGoogle Scholar
Hjorth M, Westin J, Dahl IMS, et al. Interferon-alpha 2B added to melphalan-prednisone for initial and maintenance therapy in multiple myeloma. Ann Intern Med 1996; 124: 212–22Google Scholar
Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality of life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365–76PubMedCrossRefGoogle Scholar
The Norwegian Ministry of Health. The DRG system: price list for 1996. Oslo: Mimeo, 1996Google Scholar
Koopmanschap MA, Rutten FFH, van Ineveld BM, et al. The friction cost method for measuring indirect costs of disease. J Health Econ 1995; 14: 171–89PubMedCrossRefGoogle Scholar
Gold MR, Siegel FE, Russell LB, et al. Cost-effectiveness in Health and Medicine. New York: Oxford University Press, 1996Google Scholar
Wisløff F, Eika S, Hippe E, et al. Measurement of health related quality of life in multiple myeloma. Br J Haematol 1996; 92: 604–13PubMedCrossRefGoogle Scholar
The EuroQol Group. EuroQol — a new facility for the measurement of health related quality of life. Health Policy 1990; 16: 199–208CrossRefGoogle Scholar
Nord E, Richardson J, Macarounas-Kirchmann K. Social evaluation of health care vs personal valuation of health states. Int J Technol Assess Health Care 1993; 9: 463–78PubMedCrossRefGoogle Scholar
Elvik R. The validity of using health state indexes in measuring the consequences of traffic injury for public health. Soc Sci Med 1995; 40: 1385–98PubMedCrossRefGoogle Scholar
Sintonen H. The 15-D measure of health related quality of life. Working paper 42. Melbourne: Centre for Health Program Evaluation, 1995Google Scholar
Nord E. Health index models for use in resource allocation decisions: a critical review in the light of observed preferences for social choice. Int J Technol Assess Health Care 1996; 12: 31–44PubMedCrossRefGoogle Scholar
Williams A. The measurement and valuation of health: a chronicle. Discussion paper 136. York: Centre for Health Economics, 1995Google Scholar
Rosser R, Cottee M, Rabin R, et al. Index of health-related quality of life. In: Hopkins A, editor. Measures of quality of life, and the uses to which they may be put. London: Royal College of Physicians of London, 1992Google Scholar
Sintonen H, Pekurinen M. A fifteen-dimensional measure of health related quality of life (15D) and its applications. In Walker SR, Rosser RM, editors. Quality of life assessment: key issues in the 1990s. Dordrecht: Kluwer Academic Publishers, 1993Google Scholar
Hurley S. A review of cost-effectiveness analyses. Med J Aust 1990; 153 Supp.: S20–3PubMedGoogle Scholar
Gerard K. Cost-utility in practice: a policy makers guide to the state of the art. Health Policy 1992; 21: 249–79PubMedCrossRefGoogle Scholar
Nord E. The trade-off between severity of illness and treatment effect in cost-value analysis of health care. Health Policy 1993; 24: 227–38PubMedCrossRefGoogle Scholar
Torrance GW, Feeny D. Utilities and quality-adjusted life-years. Int J Technol Assess Health Care 1989; 5: 559–75PubMedCrossRefGoogle Scholar
Smith TJ, Hillner BE, Desch CE. Efficacy and cost-effectiveness of cancer treatment: rational allocation of resources based on decision analysis. J Natl Cancer Inst 1993; 18: 1460–9CrossRefGoogle Scholar
Tsevat J, Cook EF, Green ML, et al. Health values of the seriously ill. Ann Intern Med 1994; 122: 514–20Google Scholar
Browman GP, Bergsagel D, Sicheri, et al. Randomized trial of interferon mainentance in multiple myeloma: a study of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 1995; 13: 2354–60PubMedGoogle Scholar
Ludwig H, Cohen AM, Pollack A, et al. Interferon-alpha for induction and maintenance in multiple myeloma: results of two multicenter randomized trials and summary of other studies. Ann Oncol 1995; 5: 467–76Google Scholar
Wisløff F, Hjort M, Kaasa S, et al. Effect of interferon on the health-related quality of life of multiple myeloma patients: results of a Nordic randomized trial comparing melphalanprednisone to melphalan-prednisone alpha-interferon. Br J Haematol 1996; 94: 324–32PubMedCrossRefGoogle Scholar