At ISPOR US 2022, Cytel’s HEOR & RWE experts will be contributing to a range of Issue Panels, In-person Podium Presentations showcasing top research abstracts as well as numerous Poster Sessions highlighting innovation within HEOR. I interviewed Gabriel Tremblay, VP – Advanced Analytics at Cytel, who will be presenting several posters in the area of nephropathy, COVID-19 vaccines, and other interesting topics.
Gabriel is an applied economist specializing in health economic studies and health technology assessments with nearly 15 years of experience in the pharmaceutical industry and consulting. His primary focus is on cost-effectiveness analysis and comparative effectiveness research for drugs and medical technologies. He has produced over 150 health economics and health technology assessment analyses and completed over 80 economic submissions to payers in 40 different countries.
Would you tell us a little bit about ISPOR, who attends and the range of projects that Cytel is bringing to the conference this year?
ISPOR is an important conference for health economists, statisticians, public payers and health technology assessment experts, market access experts, and students looking for work. Most of the people going to ISPOR are interested or involved in the Health Technology Assessment (HTA) process, which involves convincing public payers using supporting evidence to list healthcare products, mostly drugs and medical devices.
The range of projects we present at ISPOR can vary from one ISPOR to the other, but we typically present economic evaluations, statistical analysis, posters on methods and systematic literature reviews.
A number of your posters are in the area of nephropathy. What is nephropathy and how did you come to be working in this area?
Surprisingly, we started working in nephropathy because of COVID. As a matter of fact, COVID had a huge impact on the waiting list for kidney transplant and dialysis, which caused deterioration of patient health and outcomes at the populational level. We started working on a product that can delay or prevent the need for transplant or dialysis, which would have reduced the impact of COVID for these patients. The goal is to demonstrate that the preventative treatment here could reduce the budgetary pressures on the healthcare system for future epidemics or for the endemic phase of COVID. After working on nephropathy during COVID, we started working on other nephropathy treatments, some of which are presented at ISPOR.
What is the importance of doing economic evaluations on nephropathy?
In our case, promoting a treatment that would reduce the need for dialysis or transplant has a direct economic impact, both on the patient life expectancy and cost. In general, nephropathy will end up in end-stage renal disease at some point, and will require transplant or dialysis, which are very costly and resource intensive for the healthcare system. Promoting optimal use of resource, which is the goal of economic evaluation, can decrease this cost and improve the patient outcomes when applied at the populational level.
What were the main findings of this line of research?
In general, we find that proper treatment can save significant long-term costs of the complications of Nephropathy, including end-stage renal disease or cardiac complications.
Would you explain to us what a Royston-Parmar Flexible Parametric Survival Model is and why you are presenting on it?
Sounds like we could spend a lot of time discussing this. When we generate economic evaluation for an oncology product, we need to have the survival for patients over their lifetime. As you know, clinical trials are often much shorter than a “lifetime” and will therefore be incomplete to feed an economic model. Therefore, we need to “extrapolate” the data. When extrapolating, we often have issues matching the clinical trial data during the clinical trial, and have issues extrapolating after the end of the trial. Some more flexible techniques exist to try to better match the data, but are not used too often due to their complexity. We are trying to promote these more appropriate techniques by providing guidance on how to integrate them in economic evaluation.
What are the main findings of your simulation study with our colleagues Ho Yin Ho and Patrick Daniele?
Matching-adjusted indirect comparisons (MAICs) are a popular method of population-adjusted indirect treatment comparison used to support health technology assessment submissions. MAICs rely on a propensity score approach that rescales the weight of patients in the index trial to a target population. We sought to explore the impact of approaches used to rescale weights on the results of MAICs. Three approaches were considered for rescaling the MAIC weights: (1) raw weights; (2) effective sample size (ESS); (3) maximum rescaled weights equal to 1 (M1). We found that the weighted sample size of the adjusted individual patient data had a noticeable impact on MAIC results. This result needs to be refined by adding other types of weighting approach, so I don’t think the conclusion is the end of the tunnel for this topic.
In the meantime, this poster shows that Cytel statistical experts are using sophisticated simulation approaches to solve actual modern statistical issues that can have an impact on the decision making of healthcare payers. Simulations have become a quite pragmatic and useful way to solve statistical issues, and Cytel is driving several initiatives in the simulation field.
This year you are presenting a targeted literature review on COVID-19 vaccines. There have been a number of evaluations of COVID-19 therapies. What was distinctive of your line of enquiry, and what were your main findings?
We prepared a literature review of all the economic evaluations that were developed for COVID vaccines. Identifying the strengths and weaknesses of published analysis can help us better prepare an economic evaluation or recommend the best approach to our clients. Most of the analyses are about COVID impact or COVID therapies or COVID complications, but we focused on the vaccines. The analysis demonstrated that while there was some variation in the methodological details, there appears to be a general convergence on the assumptions and methods. The analysis demonstrated that most vaccines seem to be cost-effective, mainly due to their low cost and the relatively high efficacy at reducing serious outcomes (hospitalization, mortality). The age of the patients, vaccination coverage, inclusion of productivity loss as a variable, and the level of COVID restriction in the country seem to be the largest contributor to vaccine effectiveness.
How many times have you attended ISPOR? Is there anything about the conference this year that feels a little bit different (e.g., the types of workshops or posters being presented, or the researchers attending?).
Good question. I have been at ISPOR more than 15 times, but I would not be able to give you an actual number. This is the most important conference in our field, so I try to go every year (except for the years my kids were born). This is a strange ISPOR since it is the first time the conference is both virtual and on-site. I am eager to see if it will be able to attract as many people as usual. The theme this year is “The Future of HEOR in Patient-Driven Digital Healthcare Systems”, and I am waiting to see (on site) if there were any notable AI evolutions in HEOR and RWE.
Are there any posters or presentations from colleagues at Cytel that you are particularly looking forward to seeing?
I am a big fan of posters in the policy area, such as the poster by Allison Brackley, “Racial and Ethnic Disparities in Multiple Myeloma: Moving Towards Inclusion or at a Standstill?”. Racial disparities are marked in multiple myeloma (MM), where incidence is higher among Black and Hispanic individuals than White persons. Adequate representation of minority groups in oncology trials is critical to improve data and ameliorate outcomes; however, little is known about the progress toward this goal in MM. The poster explores regulatory and HTA agency guidance and patterns of reporting and representation in trials to understand the state of inclusion in clinical development in MM. I think it is really important for Cytel to show we can solve issues not only at the statistical level, but also at the policy level.
Are there any external posters or presentations that you especially want to attend?
I don’t look at the program in advance, but I often walk around and try to find interesting topics.
Click below to download Cytel's full list of sessions at ISPOR US 2022.
About the Author of Blog:
Mansha Sachdev specializes in content creation and knowledge management. She holds an MBA degree and has over 12 years of experience in handling various facets of marketing, across industries. At Cytel, Mansha is a Senior Content Marketing Manager and is responsible for producing informative content that is related to the pharmaceutical and medical devices industries.