VCU scientist wins senior research scholar grant to develop cost-effectiveness models for cancer treatment

By Lorraine Cichowski and Bruce Hillner

RICHMOND, Va. – Dr. Bruce E. Hillner has been awarded a $687,000, four-year Research Scholar Grant by the American Cancer Society to develop models that could help clinicians and cancer policy makers better evaluate potential treatments for cancer patients by weighing projected survival rates, enhanced quality of life and other outcomes against financial costs.

The ACS-sponsored models will offer a neutral, non-biased assessment and possible alternative to cost-effectiveness analyses done by drug and medical device companies on their own products or fill gaps where no comparisons are currently available, says Hillner, professor and associate chair of internal medicine and a nationally recognized expert on cost-effectiveness analyses.

“The rational and optimal allocation of limited financial resources is a common goal of efficient health care systems,” Hillner said. “This is true in the United States, less-developed democracies and countries financially in between. Competing demands occur among prevention, early detection, treatment, monitoring and symptom control.

“For cancer treatments, the aging of the U.S. population, the development of new technologies, expensive experimental treatment strategies and the expectations of more informed patients will place increased pressure to show the value of money from a balanced, societal perspective.”

Cost-effectiveness analyses, such as those developed by Hillner, use a multi-dimensional measure of benefit called a “quality adjust life year,” combined with financial projections. The models usually consider the cost of an intervention, such a drug or radiation therapy, as well as costs that may be caused or averted, such as hospital stays. The results, expressed in dollars spent per year of life saved, are compared against various benchmark therapies.

Cost-effectiveness analysis is becoming increasingly important with today’s rapid development of experimental drugs and treatment strategies that might have very high costs but promise only modest benefits to cancer patients in reducing tumor size or improving physical or psychological quality of life.

For example, Zevalin is an extreme example of a new class of biotech cancer treatments that uses monoclonal antibodies, armed with radioactive isotopes, to deliver radiation to lymphoma tumor cells. The therapy, which costs $28,000, has been shown to benefit a minority of advanced lymphoma patients in delaying the progression of their cancers, but it has not been shown to improve survival.

Hillner will assess cost effectiveness, using a 16-point checklist, and develop models in three treatment situations involving breast and colon cancer and lymphoma:

• When the maker of a new cancer tool cannot objectively address its relative value to a specific society,

• When comparative randomized clinical trials involving a cancer treatment are unlikely to be performed and

• When early-detection and treatments are recommended for less-developed countries where the standards of more-developed countries cannot be applied.

Hillner’s project also will look at the cost-benefit implications of highly anticipated clinical trials whose results are imminent.