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Picot J, Cooper K, Bryant J, et al. The Clinical Effectiveness and Cost-Effectiveness of Bortezomib and Thalidomide in Combination Regimens with an Alkylating Agent and a Corticosteroid for the First-Line Treatment of Multiple Myeloma: A Systematic Review and Economic Evaluation. Southampton (UK): NIHR Evaluation, Trials and Studies Coordinating Centre (UK); 2011 Dec. (Health Technology Assessment, No. 15.41.)

Appendix 14Parameters included in the sensitivity analyses

The ranges used for the deterministic analyses and PSAs are reported in this appendix. Where appropriate, parameters were assigned a distribution in the PSA. Distributions were chosen according to the methodology suggested by Briggs and colleagues.103 They suggest that the normal distribution is a ‘candidate distribution for representing the uncertainty in any parameter in the model’. Further, they suggest the beta distribution for binomial outcomes, where parameters can vary between zero and one, for example probabilities, and the gamma distribution for costs where parameters are non-negative.

  • Discount rates were varied between 2% and 5% for costs and benefits in the deterministic sensitivity analyses.
  • The number of cycles for each of the treatments varied between seven and nine. For each of the interventions, we assumed a range between one fewer than the mean to one more than the mean. The number of cycles was assumed to follow a normal distribution.
  • Second-line treatment was varied according to the proportion who had bortezomib and HDD. For MP, MPT and CTDa, the proportion varied between 60% and 80% and for VMP, the proportion varied between 5% and 25%.
  • The range for the utility values was assumed to be ± 10% of the mean utility values, based on the uncertainty in the utility values from the MMIX Trial. We analysed the HRQoL data from the MMIX Trial. (AiC and/or CiC information has been removed.) Utility values were sampled from a beta distribution.
  • The CR data were obtained from the trials and SEs were derived. Values were sampled from a beta distribution.
  • The costs for AEs, bortezomib administration and consultation were assumed to vary within the range ± 30% of the mean and were sampled from a gamma distribution.
  • The ranges for the HRs and event rates for the MP survival curves were taken from the trial data. Values were sampled from a log-normal distribution.
  • The costs for AEs, bortezomib administration and consultation were varied within ± 30% of the mean for the deterministic sensitivity analysis.

Parameters and distributions for the deterministic and probabilistic sensitivity analyses

NameMeanCISEDistribution
HigherLower
Discount rate
Discount rate costs (%)3.55.02.0NA
Discount rate benefits (%)3.55.02.0NA
Cycles of treatment
cycle_MP8970.5102Log normal
cycle_MPT8970.5102Log normal
cycle_VMP91080.5102Log normal
cycle_CTDa7860.5102Log normal
Subsequent treatment, Bort.
Sub_treat_Bort_MP7080605.1020Log normal
Sub_treat_Bort_MPT7080605.1020Log normal
Sub_treat_Bort_VMP152555.1020Log normal
Sub_treat_Bort_CTDa7080605.1020Log normal
Utility values
u_treatment0.580.6390.5220.030Beta
u_response(AiC/CiC information has been removed)(AiC/CiC information has been removed)(AiC/CiC information has been removed)(AiC/CiC information has been removed)Beta
u_progression0.680.7480.6120.035Beta
CR
CR_MP0.0260.0350.0170.005Beta
CR_MPT0.1420.3070.0660.084Beta
CR_VMP0.2170.3860.1210.087Beta
CR_CTDa(AiC/CiC information has been removed)(AiC/CiC information has been removed)(AiC/CiC information has been removed)(AiC/CiC information has been removed)Beta
AEs (£ per cycle)
cAE_MP45.6359.3231.946.98Gamma
cAE_MPT70.4091.5249.2810.78Gamma
cAE_VMP73.1695.1151.2111.20Gamma
cAE_CTDa72.4594.1950.7211.09Gamma
Other
Cost of bortezomib administration (£)153.40199.42107.3823.4796Gamma
Outpatient appointment medical oncology (£)121.11157.4484.7818.5372Gamma
Survival curve parameters
Multipliers
MP OS baseline curve0.0280.0390.0200.0041Log normal
MP PFS baseline curve0.0670.0700.0600.0036Log normal
HR OS MPT0.620.820.500.0714Log normal
HR OS VMP0.620.830.510.0714Log normal
HR OS CTDa(AiC/CiC information has been removed)(AiC/CiC information has been removed)(AiC/CiC information has been removed)(AiC/CiC information has been removed)Log normal
HR PFS MPT0.580.770.490.0612Log normal
HR PFS VMP0.580.760.480.0612Log normal
HR PFS CTDa(AiC/CiC information has been removed)(AiC/CiC information has been removed)(AiC/CiC information has been removed)(AiC/CiC information has been removed)Log normal
Cost of treatments
Unit cost bortezomib (£)762.38914.86609.9077.7939NA
Unit cost thalidomide (£)298.48358.18238.7830.4571NA
Dosage thalidomide (mg/day)15020010025.5102Log normal

NA, not applicable.

© 2011, Crown Copyright.

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Cover of The Clinical Effectiveness and Cost-Effectiveness of Bortezomib and Thalidomide in Combination Regimens with an Alkylating Agent and a Corticosteroid for the First-Line Treatment of Multiple Myeloma: A Systematic Review and Economic Evaluation
The Clinical Effectiveness and Cost-Effectiveness of Bortezomib and Thalidomide in Combination Regimens with an Alkylating Agent and a Corticosteroid for the First-Line Treatment of Multiple Myeloma: A Systematic Review and Economic Evaluation.
Health Technology Assessment, No. 15.41.
Picot J, Cooper K, Bryant J, et al.

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