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Economic analyses of well-conducted clinical trials are critical to rational health policy that informs value-based decision making. Trial economic analyses, such as cost-effectiveness analysis, often rely on trial-collected data, which are burdensome and expensive to collect. In contrast, administrative databases systematically collect health system encounters and are available at low cost for nearly all patients with cancer in Ontario, Canada, and many other jurisdictions.
Objectives and Approach
We investigated whether administrative data could improve the performance of trial economic analysis. Health administrative data were probabilistically linked to 148 Ontario patients from the Canadian Cancer Trials Group CO.17 trial (n=572), which evaluated cetuximab plus best supportive care (n=75) versus best supportive care alone (n=73) in previously treated metastatic colorectal cancer. Trial-collected resource utilization data and vital status were compared with administrative data. Cost-effectiveness in 2007 Canadian dollars according to administrative data was determined with bootstrap incremental cost-effectiveness ratio (ICER) confidence intervals (CIs).
Up to trial date of last contact, administrative data vital status was concordant in >96%. Twenty-nine subsequent deaths occurred. Up to trial last contact, there were 50 net additional hospitalizations and 33 net additional emergency department visits in administrative data. Total costs were $3,023,034 for the cetuximab group and $1,191,118 for the control group up to trial last contact. ICER was $211,128 per life-year gained (90% CI: $101,396 to $694,950) up to trial last contact and $164,378 (90% CI: -$138,260 to $644,555) up to administrative data last contact. ICER estimates were similar to analyses using trial-collected data.
Administrative data were more complete than trial data for hospital encounters, a key cost driver in economic analysis and there was longer follow-up. This study demonstrates the potential of administrative data to relieve the burden of collecting key data in cancer trials, which represents considerable effort and expense.
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