KEY TAKEAWAYS
- The trial aimed to compare the cost-utility of GAM with usual care in older adults with cancer.
- The primary outcome was to evaluate the INMB. Missing data was handled using multiple imputation, and 95% CI were computed using bootstrapping.
- The study found GAM was cost-effective for cancer pts treated with curative intent but not for palliative pts.
Geriatric assessment is a recommended way to improve cancer care for older adults. Researchers aimed to compare the cost-utility of geriatric assessment and management (GAM) with usual care in older adults with cancer.
The study conducted an economic evaluation over a 12-month period and took a societal perspective. In the 5C study, patients(pts) aged 65 and above from 8 Canadian hospitals were randomly assigned to receive either GAM or standard care. These pts were starting systemic therapy, either for curative or palliative purposes. Quality-adjusted life years (QALYs) were assessed using the EQ-5D-5L questionnaire. Healthcare utilization was analyzed through cost diaries and chart reviews. The primary outcome, incremental monetary benefit (INMB), was assessed for the entire sample and specific subgroups. Missing data were addressed using multiple imputations, and 95% confidence intervals (CI) were calculated using bootstrapping.
The study involved 350 pts (173 receiving GAM, 177 receiving usual care); at 12 months, the average QALYs were 0.747 for GAM and 0.753 for usual care (ΔQALY = -0.006, 95%CI: -0.06 to 0.05). The total average costs were $48,397 for GAM and $45,342 for usual care (ΔCost = $3,078, 95% CI: -$5,336 to $12,050). At a cost-effectiveness threshold of $50,000/QALY, GAM was not cost-effective compared to usual care (INMB: -$3,962, 95% CI: -$7,117 to -$794). In a subgroup analysis, GAM was cost-effective for pts with curative intent (INMB: $4,639, 95% CI: $61 to $8,607) in 78% of simulations but not for pts with palliative intent (INMB: -$13,307, 95% CI: -$18,063 to -$8,264).
The study found GAM was cost-effective for cancer pts treated with curative intent but not for palliative pts. Extrapolating to positive GAM trials will provide a more complete picture of GAM’s cost-effectiveness in this setting.
Source: https://ascopubs.org/doi/abs/10.1200/JCO.2023.41.16_suppl.12012?role=tab
Clinical Trial: https://www.clinicaltrials.gov/study/NCT03154671
Yeva Sahakyan, Qixuan Li, Lusine Abrahamyan, Martine Puts, Sarah Brennenstuhl, Mohammed Rashidul Anwar, Shant Yeretzian, Emma Matosyan, Bianca Mclean, Fay Strohschein, Aria Wills, George Tomlinson, and Shabbir M.H. Alibhai. DOI: 10.1200/JCO.2023.41.16_suppl.12012 Journal of Clinical Oncology 41, no. 16_suppl (June 01, 2023) 12012-12012.
