Show simple item record

dc.contributor.advisorBarry, Michaelen
dc.contributor.authorGORRY, CLAIRE MARIEen
dc.date.accessioned2020-10-13T10:23:45Z
dc.date.available2020-10-13T10:23:45Z
dc.date.issued2020en
dc.date.submitted2020en
dc.identifier.citationGORRY, CLAIRE MARIE, Cost Effectiveness of Treatment Strategies for Skin Cancer in the Irish Healthcare Setting, Trinity College Dublin.School of Medicine, 2020en
dc.identifier.otherYen
dc.identifier.urihttp://hdl.handle.net/2262/93750
dc.descriptionAPPROVEDen
dc.description.abstractThe incidence of both non-melanoma skin cancer (NMSC) and melanoma skin cancer are increasing in Ireland and are associated with significant healthcare costs. Cost-effectiveness analysis (CEA) can assist in resource allocation decisions which maximise health gain from a fixed healthcare budget. The aim of this thesis is to investigate the cost-effectiveness of treatment modalities for NMSC and melanoma skin cancer in Ireland. A simple decision tree model was developed to investigate the cost effectiveness of Mohs surgery compared to traditional surgical excision (TSE). Quality of life and utility data was collected from an Irish patient cohort with NMSC. There was no improvement in utility post- removal with either intervention. Assessments of responsiveness, sensitivity and construct validity did not support the validity of EQ-5D-3L in this condition. Mohs was associated with an increase in costs and marginal increase in quality adjusted life years (QALYs) compared to TSE in both primary and recurrent basal cell carcinomas (BCC), the most common type of NMSC. Mohs could be considered cost-effective for the treatment of recurrent BCC in Ireland. A systematic review of published CEAs of systemic treatments for advanced melanoma was conducted, which concluded that the outcomes of published CEAs were not transferable to the Irish setting. To derive clinical efficacy inputs for a de novo CEA, a systematic review and network meta-analysis was undertaken. This review identified 35 trials pertaining to nine drug treatments licensed in Ireland for the treatment of advanced melanoma. Immunotherapy and targeted treatments were more effective than chemotherapy in treatment naïve patients with and without the BRAF mutation respectively; results were less conclusive in the treatment refractory population. In the de novo CEA, eight regimens were compared to chemotherapy across three distinct patient populations using cost utility analysis. The model was developed in accordance with the requirements of the Irish reference case for CEA. At a cost-effectiveness threshold of 45,000 per QALY, the new regimens were not cost effective compared to chemotherapy. Dominant options were identified in both BRAF wildtype and BRAF mutation positive populations. Preliminary research for a CEA of adjuvant treatment for stage III melanoma was conducted. Budget impact analysis projected a drugs budget impact of 100 million with new adjuvant treatments. Analysis of drug reimbursement data identified the most appropriate comparator for a CEA of adjuvant treatment as routine observation. A proposed structure for a de novo CEA is proposed, based on literature review of published models. A Cochrane systematic review was conducted to identify the clinical evidence base for neoadjuvant treatment for melanoma. Heterogeneity between the trials in terms of treatment regimens, design and population precluded meta-analysis. There is presently insufficient evidence to support the use of neoadjuvant treatment outside of clinical trials. The findings presented in this thesis present numerous issues for consideration by decision makers. Currently reimbursed treatments for melanoma are unlikely to be cost effective. The identification of dominant options presents opportunities for divestment and more cost-effective prescribing, to optimise health gain within this patient population.en
dc.publisherTrinity College Dublin. School of Medicine. Discipline of Pharmacology & Therapeuticsen
dc.rightsYen
dc.subjectPharmacoeconomicsen
dc.subjectMelanomaen
dc.subjectCost Effectivenessen
dc.subjectHealth Technology Assessmenten
dc.subjectSkin Canceren
dc.titleCost Effectiveness of Treatment Strategies for Skin Cancer in the Irish Healthcare Settingen
dc.typeThesisen
dc.contributor.sponsorNational Centre for Pharmacoeconomicsen
dc.type.supercollectionthesis_dissertationsen
dc.type.supercollectionrefereed_publicationsen
dc.type.qualificationlevelDoctoralen
dc.identifier.peoplefinderurlhttps://tcdlocalportal.tcd.ie/pls/EnterApex/f?p=800:71:0::::P71_USERNAME:GORRYCMen
dc.identifier.rssinternalid220756en
dc.rights.ecaccessrightsopenAccess


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record