***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose .To provide a practical quantitative tool for appraising the quality of  cost-effectiveness ( CE ) studies . Methods .A committee comprised of health economists selected a set of criteria for the instrument from an item pool . Data collected with a conjoint analysis survey on 120 international health economists were used to estimate weights for each criterion with a r and om effects regression model . To vali date the grading system , a survey was sent to 60 individuals with health economics expertise . Participants first rated the quality  of three CE studies  on a visual analogue scale , and then evaluated each study using the  grading system . Spearman rho and Wilcoxon tests were used to detect convergent validity and analysis of covariance ( ANCOVA ) for discriminant validity . Agreement between the global rating by experts and the grading system was also examined . Results .Sixteen criteria were selected . Their coefficient estimates ranged from 1.2 to 8.9 , with a sum of 93.5 on a 100-point scale . The only insignificant criterion was “ use of subgroup analyses . ” Both convergent validity and discriminant validity of the grading system were shown by the results of the Spearman rho ( correlation coefficient = 0.78 , P < 0.0001 ) , Wilcoxon test ( P = 0.53 ) , and ANCOVA ( F3,146 = 5.97 , P = 0.001 ) . The grading system had good agreement with global rating by experts . Conclusions . The instrument appears to be simple , internally consistent , and valid for measuring the perceived quality of CE studies . Applicability for use in clinical and re source allocation decision-making deserves further study This study evaluated the cost effectiveness of  bortezomib  in relapsed , refractory myeloma , relative to best supportive care ( BSC ) and thalidomide . Data were derived from the phase 2 pivotal study of bortezomib  , a Delphi panel of six myeloma thought leaders , and published literature . Objective assumptions regarding treatment choices and consequences ( response and complications ) , and actual cost data were used . Bortezomib was found to be cost effective relative to BSC and thalidomide . Sensitivity analyses demonstrated the robustness of the results . These data suggest that bortezomib provides a cost-effective treatment option and the best value ( in terms of cost/life-yr gained ) among the currently available therapeutic options for relapsed , refractory myeloma We compared the three arms of the MM-015 r and omized phase III clinical trial [ melphalan and prednisone ( MP ) , MP plus lenalidomide ( MPR ) , and MPR plus lenalidomide maintenance ( MPR-R ) ] to determine whether the addition of lenalidomide maintenance therapy for primary treatment of multiple myeloma is cost-effective . We used progression-free survival and adverse event data from the MM-015 study for the analysis . Two novel measures of cost-effectiveness termed the Average Cumulative Cost per Patient ( ACCP ) and the Average Cumulative Cost per Progression-Free Survivor ( ACCPFS ) were developed for the purpose of this analysis . The ACCP of MP was USD 18,218 , compared to USD 167,862 for MPR and USD 309,173 for MPR-R. The ACCPFS was highest with MPR at USD 1,555,443 , while MP was USD 313,592 and MPR-R was USD 690,111 . MPR-R is superior to MPR in terms of preventing the first progression after initial therapy . However , the addition of lenalidomide to MP in the induction and also in the maintenance setting leads to significant costs High dose chemotherapy with autologous stem cell transplantation ( ASCT ) improves outcomes in patients 65 years of age or less with multiple myeloma .  Survival and costs in a cohort of 16 patients who received melphalan and prednisone as part of a clinical trial were compared with those of 36 patients referred to our centre for consideration of ASCT . In the transplant group , survival and costs were extrapolated to match the period of observation in the melphalan and prednisone group . Patient-specific and average costs were calculated from the perspective of the Ontario Ministry of Health . Costs and survival were varied by 50 % in the sensitivity analysis . Transplantation improved life expectancy by 19.3 months with a cost difference of $ 30,517 Canadian . The incremental cost-effectiveness of transplantation compared with melphalan and prednisone was $ 25,710 Canadian per life-year gained when additional pamidronate and follow-up costs were considered . Discounting costs and survival at 3 and 5 % did not result in important differences . The sensitivity analysis result ed in best and worse case scenarios for transplantation compared with melphalan and prednisone of $ 13,049 and $ 63,954 per life-year gained respectively . In comparison with melphalan and prednisone , ASCT appears to be cost-effective in patients 65 years old or younger with myeloma The outlook for transplant-ineligible multiple myeloma patients has improved enormously over recent years with the incorporation of new agents into st and ard regimens . Novel regimens combine melphalan and prednisone ( MP ) with bortezomib ( VMP ) , with thalidomide ( MPT ) , and with lenalidomide with ( MPR-R ) and without ( MPR ) lenalidomide maintenance . The efficacy , safety , and cost-effectiveness of these regimens have not yet been compared ; therefore , we conducted a pharmacoeconomic analysis using data from r and omized controlled trials versus MP . Using a Markov model developed from a U.S. payer 's perspective , we compared VMP with MPT and MPR-R over a lifetime horizon . MPT and MPR-R were chosen because , like VMP , they are superior to MP in response and outcomes . Data from the Velcade as Initial St and ard Therapy in Multiple Myeloma ( VISTA ; VMP ) , Intergroupe Francophone du Myelome ( IFM ) 99 - 06 ( MPT ) , and MM-015 ( MPR-R ) trials were used . The IFM 99 - 06 study was selected because of the superior activity in this study compared with other MPT studies . Using patient-level ( VMP ) and published ( MPT , MPR-R ) data , we estimated the health-state transition and adverse event probabilities for each regimen , related costs , and state-specific utility estimates . Costs ( in 2010 U.S. dollars ) and health outcomes were discounted at 3 % . Discounted lifetime direct medical costs were lowest with VMP at $ 119,102 . MPT cost $ 142,452 whereas MPR-R cost $ 248,358 . Incremental cost-effectiveness ratio calculations projected that VMP would confer cost savings and better health outcomes relative to MPT and MPR-R. We conclude that VMP is highly likely to be cost-effective compared with MP , MPT , and 
    Output:
    
For transplant-eligible MM patients , transplant is a cost-effective first-line treatment .
In the second-line setting , it is unclear which novel agent-based regimen is most cost effective , but bortezomib-based regimens , lenalidomide plus dexamethasone , and pomalidomide plus dexamethasone were each cost effective compared with dexamethasone alone