title: Cost-effectiveness of strain-targeted cardioprotection for prevention of chemotherapy-induced cardiotoxicity.
abstract: 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.
authors.affiliation: Menzies Institute for Medical Research, Hobart, Australia.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Nolan
authors.affiliation: Baylor College of Medicine, Houston, TX, United States.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Plana
authors.affiliation: Toronto General Hospital, University of Toronto, Toronto, Canada.
authors.forename: Paaladinesh
authors.initials: P
authors.lastname: Thavendiranathan
authors.affiliation: Emory University, Atlanta, GA, United States.
authors.forename: Leslee
authors.initials: L
authors.lastname: Shaw
authors.affiliation: Menzies Institute for Medical Research, Hobart, Australia.
authors.forename: Lei
authors.initials: L
authors.lastname: Si
authors.affiliation: Menzies Institute for Medical Research, Hobart, Australia; Baker-IDI Heart and Diabetes Institute, Melbourne, Australia. Electronic address: Tom.Marwick@bakeridi.edu.au.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics; D066126:Cardiotoxicity / Q000517:prevention & control*; D000066491:Clinical Decision-Making; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Cardiotoxicity; Chemotherapy; Cost effectiveness; Decision-making