European journal of cancer : official journal for European Organization for Research and Treatment of Cancer (EORTC) [and] European Association for Cancer Research (EACR)
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
The real costs of emesis--an economic analysis of ondansetron vs. metoclopramide in controlling emesis in patients receiving chemotherapy for cancer.
The cost effectiveness of ondansetron was compared with that of metoclopramide in the prevention of acute emesis due to highly emetogenic chemotherapy in an open, randomised, parallel group pilot study. Ondansetron was given as three 8 mg intravenous doses (0, 4 and 8 h) and metoclopramide as an intravenous loading dose (3 mg/kg) followed by a maintenance dose of 0.5 mg/kg/h for 8 h. ⋯ The cost per successfully treated patient (< or = 1 emetic episode and no adverse events) was 95.20 pounds for ondansetron and 92.18 pounds for metoclopramide. The results of the study therefore suggest that for the control of acute emesis due to highly emetogenic chemotherapy ondansetron and metoclopramide are equally cost-effective treatments.
-
Multicenter Study
Quality of life assessment in individuals with lung cancer: testing the Lung Cancer Symptom Scale (LCSS).
This paper presents the continued development and multi-institutional testing of an instrument focusing on measuring the physical and functional dimensions of quality of life. It emphasises evaluation of symptoms associated with lung cancer and their effect on activity status. The Lung Cancer Symptom Scale (LCSS) is a disease- and site-specific instrument which has both a patient and an observer (health care professional) form. ⋯ Using the same rule of agreement as for Kappa (+/- one category) intrarater agreement was 95-100% for all 21 raters. Past test re-test reliability indicated high patient reproducibility for 52 patients (r > 0.75, P < 0.01 for all items). We conclude that (1) the LCSS demonstrates good feasibility, reliability, and content validity, (2) high interrater reliability indicates utility in multicentre trials, and (3) continued testing for internal consistency, construct validity and criterion-related validity is warranted.
-
A recent extension of clinical evaluation is "economic evaluation", which seeks to characterise each relevant alternative health care strategy in terms of a summary measure incorporating the costs and benefits of such strategies. In an economic evaluation, separate measurements of resource volumina and resource prices on the cost side, and separate measurements of survival and quality of life effects and valuation of these outcome effects on the benefit side are required. From these effect parameters, which should be calculated for all competing strategies considered in the analysis, the relative cost-effectiveness of one strategy as against the other can be derived. ⋯ This depends on the generalisability of the clinical findings, and in this respect the so-called "piggyback" economic evaluation, which is added to a clinical trial, has its limitations. In the field of cancer, specific attention should be given to costs and effects occurring after non-mortality endpoints, to patient and family costs and to variations in treatments between settings of care. It is argued that conventional clinical trials and economic evaluations will integrate further in the future.