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dc.contributor.advisorSkrepnek, Granten
dc.contributor.authorKalla, Kelly
dc.contributor.authorFrancis, Laura
dc.contributor.authorPowers, Kimberleigh
dc.date.accessioned2017-06-27T18:18:00Z
dc.date.available2017-06-27T18:18:00Z
dc.date.issued2006
dc.identifier.urihttp://hdl.handle.net/10150/624445
dc.descriptionClass of 2006 Abstracten
dc.description.abstractDoxorubicin is a member of the anthracycline antibiotic class of chemotherapeutic agents and is among the most effective chemotherapies in the treatment of breast cancer1. However, the efficacy of the drug is limited by its ability to cause a heart failure. In younger women with high – risk breast cancers, doxorubicin improves their chances of survival from the breast cancer, but the risk of heart failure, should they survive, will shorten their lives substantially and reduce their quality of life. Periodic monitoring of left ventricular ejection fraction (LVEF) during treatment with doxorubicin has been shown to reduce morbidity and mortality from doxorubicin – induced heart failure19 and for the past 20 years, the Schwartz guidelines have provided an algorithm for the frequency of LVEF monitoring19. According to this guideline, women in their 30’s who are otherwise healthy do not receive LVEF monitoring until they have received a threshold dose of 250-300mg/m2. We have conducted a decision – analysis cost – effectiveness study of heart failure prevention by LVEF monitoring with equilibrium radionuclide angiography (ERNA) either in adherence to the Schwartz guidelines or before each dose of doxorubicin (serial monitoring). Our findings show that, both in terms of quality of life and cost outcomes, ERNA monitoring of LVEF according to the Schwartz guidelines is the dominant strategy. Monte Carlo analysis of 5000 patients showed that the Schwartz guidelines have an average cost- effectiveness of $110/QALY, versus $390/QALY for serial monitoring. Sensitivity analysis of uncertain variables invariably showed that Schwartz guidelines are dominant.
dc.language.isoen_USen
dc.publisherThe University of Arizona.en
dc.rightsCopyright © is held by the author.en
dc.subjectBreast Canceren
dc.subjectDoxorubicinen
dc.subjectMonitoringen
dc.subjectCost-Efficacyen
dc.subjectHeart Failureen
dc.subject.meshBreast Neoplasmsen
dc.subject.meshDoxorubicinen
dc.subject.meshCardiomyopathiesen
dc.subject.meshMonitoring, Physiologicen
dc.titleCost-Efficacy of Monitoring for Adriamycin-Induced Cardiomyopathy by Equilibrium Radionuclide Angiocardiography in a Low-Risk 35-year old Female Treated for Stage IIB Breast Cancer: A Decision- Analysisen_US
dc.typetexten
dc.typeElectronic Reporten
dc.contributor.departmentCollege of Pharmacy, The University of Arizonaen
dc.description.collectioninformationThis item is part of the Pharmacy Student Research Projects collection, made available by the College of Pharmacy and the University Libraries at the University of Arizona. For more information about items in this collection, please contact Jennifer Martin, Associate Librarian and Clinical Instructor, Pharmacy Practice and Science, jenmartin@email.arizona.edu.en
html.description.abstractDoxorubicin is a member of the anthracycline antibiotic class of chemotherapeutic agents and is among the most effective chemotherapies in the treatment of breast cancer1. However, the efficacy of the drug is limited by its ability to cause a heart failure. In younger women with high – risk breast cancers, doxorubicin improves their chances of survival from the breast cancer, but the risk of heart failure, should they survive, will shorten their lives substantially and reduce their quality of life. Periodic monitoring of left ventricular ejection fraction (LVEF) during treatment with doxorubicin has been shown to reduce morbidity and mortality from doxorubicin – induced heart failure19 and for the past 20 years, the Schwartz guidelines have provided an algorithm for the frequency of LVEF monitoring19. According to this guideline, women in their 30’s who are otherwise healthy do not receive LVEF monitoring until they have received a threshold dose of 250-300mg/m2. We have conducted a decision – analysis cost – effectiveness study of heart failure prevention by LVEF monitoring with equilibrium radionuclide angiography (ERNA) either in adherence to the Schwartz guidelines or before each dose of doxorubicin (serial monitoring). Our findings show that, both in terms of quality of life and cost outcomes, ERNA monitoring of LVEF according to the Schwartz guidelines is the dominant strategy. Monte Carlo analysis of 5000 patients showed that the Schwartz guidelines have an average cost- effectiveness of $110/QALY, versus $390/QALY for serial monitoring. Sensitivity analysis of uncertain variables invariably showed that Schwartz guidelines are dominant.


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