Clinical and economic impact of multiple gated acquisition scan monitoring during anthracycline therapy

• Published in: British journal of cancer Vol. 86; no. 2; pp. 226 - 232
• Main Authors: SHUREIQI, I, CANTOR, S. B, LIPPMAN, S. M, BRENNER, D. E, CHERNEW, M. E, FENDRICK, A. M
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 21.01.2002
• Subjects: Adolescent; Adult; Aged; Antineoplastic Agents - adverse effects; Biological and medical sciences; Cancer research; Cancer therapies; Cardiotoxicity; Chemotherapy; Clinical; Cost-Benefit Analysis; Decision Support Techniques; Doxorubicin - adverse effects; Drug toxicity and drugs side effects treatment; Economic impact; Ejection fraction; Female; Gated Blood-Pool Imaging - economics; Health Care Costs - statistics & numerical data; Heart failure; Heart Failure - chemically induced; Heart Failure - diagnostic imaging; Humans; Male; Medical research; Medical sciences; Middle Aged; Neoplasms - drug therapy; Patients; Pharmacology. Drug treatments; Predictive Value of Tests; Retrospective Studies; Stroke Volume; Survival Analysis; Toxicity: cardiovascular system; Ventricular Function, Left; United States; North America; America; United States > US; Antineoplastic agent; Toxicity; Cardiovascular disease; Doxorubicin; Isomerases; Heart disease; Lymphoproliferative syndrome; Complication; Public health; Cost efficiency analysis; Human; Heart failure; DNA topoisomerase (ATP-hydrolysing); Enzyme; Enzyme inhibitor; Hodgkin disease; Malignant hemopathy; Lymphoma; Left ventricle; Ventriculography; Antibiotic; Chemotherapy; Treatment; Health economy; Medical imagery; Anthracyclins; Ejection fraction
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/sj.bjc.6600037

The clinical and economic impacts of monitoring cardiac function in patients given doxorubicin have yet to be determined, especially in relation to patient age, cumulative doxorubicin dose, and the relative efficacies of doxorubicin-based vs alternative regimens. We developed a decision analysis model that includes these factors to estimate the incremental survival benefit and cost-effectiveness of using multiple gated acquisition scans to measure left-ventricular ejection fraction before and during doxorubicin chemotherapy. Probability distributions for the incidences of abnormal left-ventricular ejection fraction findings and congestive heart failure were derived from a retrospective review of 227 consecutive cases at The University of Michigan Medical Center and published findings. Multiple gated acquisition-scan monitoring minimally improved the probability of 5-year survival (<1.5% in the base--case scenario). For patients who received up to 350 mg m(-2) of doxorubicin, multiple gated acquisition-scan screening had an incremental cost of $425 402 per life saved for patients between the ages of 15--39. This incremental cost markedly decreased to $138 191, for patients between the ages of 40--59, and to $86 829 for patients older than 60 years. The small gain in 5-year survival probability secondary to multiple gated acquisition scan monitoring doubled for all age groups when the average cumulative dose for doxorubicin reached 500 mg m(-2). Variations in the cure rate differences between the doxorubicin and alternative regimens had insignificant effects on the improvement in 5-year survival rates from multiple gated acquisition-scan screening. The use of multiple gated acquisition scans for pretreatment screening appears to be more cost-effective for patients who are 40 years or older, when cumulative doxorubicin dose is 350 mg m(-2) or less.