Matthew C Cheung

Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

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Publications (65)271.82 Total impact

  • Karen Lien · Matthew C Cheung · Kelvin K W Chan
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    ABSTRACT: As costs of cancer care rise, there has been a shift to focus on value. Drug wastage affects costs to patients and health care systems without adding value. Historically, cost-effectiveness analyses have used models that assume no drug wastage; however, this may not reflect real-world practices. We sought to identify the frequency of drug wastage modeling in economic evaluations of modern parenteral therapies for hematologic malignancies. We conducted a systematic literature review of economic evaluations of new US Food and Drug Administration-approved parenteral chemotherapies with indications for the treatment of hematologic malignancies. The primary outcome of interest was the proportion of studies that modeled drug wastage in base-case analyses. If wastage was considered in primary analyses, we reported the impact of wastage on incremental cost-effectiveness ratios (ICERs) and drug acquisition costs. Wastage was considered in base-case analyses in less than one third of all publications reviewed (12 of 38; 32%). Of these, two studies went on to complete sensitivity analyses and reported significant changes in the calculated ICER as a result. In one study, the ICER increased by 32%, and in the second, accounting for wastage changed a positive ICER to a dominant result. Potential costs associated with drug wastage are considered in only one third of modern cost-effectiveness models. The impact of wastage on calculated ICERs and drug acquisition costs is potentially substantial. The modeling of wastage in base-case and sensitivity analyses is recommended for future economic evaluations of new intravenous therapies for hematologic malignancies. Copyright © 2015 by American Society of Clinical Oncology.
    Journal of Oncology Practice 09/2015; DOI:10.1200/JOP.2015.005876
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    ABSTRACT: The NCIC CTG LY.12 study showed that gemcitabine, dexamethasone, and cisplatin (GDP) were noninferior to dexamethasone, cytarabine, and cisplatin (DHAP) in patients with relapsed or refractory aggressive histology lymphoma prior to autologous stem cell transplantation. We conducted an economic evaluation from the perspective of the Canadian public healthcare system based on trial data. The primary outcome was an incremental cost utility analysis comparing costs and benefits associated with GDP vs DHAP. Resource utilization data were collected from 519 Canadian patients in the trial. Costs were presented in 2012 Canadian dollars and disaggregated to highlight the major cost drivers of care. Benefit was measured as quality-adjusted life-years (QALYs) based on utilities translated from prospectively collected quality-of-life data. All statistical tests were two-sided. The mean overall costs of treatment per patient in the GDP and DHAP arms were $19 961 (95% confidence interval (CI) = $17 286 to $24 565) and $34 425 (95% CI = $31 901 to $39 520), respectively, with an incremental difference in direct medical costs of $14 464 per patient in favor of GDP (P < .001). The predominant cost driver for both treatment arms was related to hospitalizations. The mean discounted quality-adjusted overall survival with GDP was 0.161 QALYs and 0.152 QALYs for DHAP (difference = 0.01 QALYs, P = .146). In probabilistic sensitivity analysis, GDP was associated with both cost savings and improved quality-adjusted outcomes compared with DHAP in 92.6% of cost-pair simulations. GDP was associated with both lower costs and similar quality-adjusted outcomes compared with DHAP in patients with relapsed or refractory lymphoma. Considering both costs and outcomes, GDP was the dominant therapy. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail:
    Journal of the National Cancer Institute 07/2015; 107(7). DOI:10.1093/jnci/djv106 · 12.58 Impact Factor
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    ABSTRACT: The treatment of transformed indolent lymphoma (TRIL) often includes salvage chemotherapy (SC) and autologous stem cell transplant (ASCT). NCIC CTG LY12 is a randomized phase III trial comparing gemcitabine, dexamethasone, cisplatin (GDP) to dexamethasone, cytarabine, cisplatin (DHAP) prior to ASCT. This analysis compares the results of SC and ASCT for TRIL with de novo diffuse large B cell lymphoma (DL). Six hundred nineteen patients with relapsed/refractory aggressive NHL were randomized to GDP or DHAP; 87 patients (14%) had TRIL and 429 (69%) had DLBCL. The response rate to SC was 47% in TRIL and 45% in DL (p=0.81). Transplantation rates were similar: TRIL: 53%; DL: 52% (p=1.0). With a median follow-up of 53 months, 4 year OS was 39% for TRIL and 41% for DL (p=0.78); 4 year EFS was 27% for TRIL and 27% for DL (p=0.83). Post-ASCT, 4 year EFS was 45% for TRIL and 46% for DL. Histology (TRIL or DL) was not a predictor of any outcome in multivariate models. Patients with relapsed or refractory TRIL and DLBCL have similar outcomes with SC and ASCT; this therapy should be considered the standard of care for patients with TRIL who have received prior systemic chemotherapy. NCIC CTG LY12 is registered to as NCT00078949. Copyright © 2015 American Society of Hematology.
    Blood 06/2015; 126(6). DOI:10.1182/blood-2015-01-622084 · 10.45 Impact Factor
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    ABSTRACT: BACKGROUNDA significant share of the cost of cancer care is concentrated in the end-of-life period. Although quality measures of aggressive treatment may guide optimal care during this timeframe, little is known about whether these metrics affect costs of care.METHODS This study used population data to identify a cohort of patients who died of cancer in Ontario, Canada (2005-2009). Individuals were categorized as having received or having not received aggressive end-of-life care according to quality measures related to acute institutional care or chemotherapy administration in the end-of-life period. Costs (2009 Canadian dollars) were collected over the last month of life through the linkage of health system administrative databases. Multivariate quantile regression was used to identify predictors of increased costs.RESULTSAmong 107,253 patients, the mean per-patient cost over the final month was $18,131 for patients receiving aggressive care and $12,678 for patients receiving nonaggressive care (P < .0001). Patients who received chemotherapy in the last 2 weeks of life also sustained higher costs than those who did not (P < .0001). For individuals receiving end-of-life care in the highest cost quintile, early and repeated palliative care consultation was associated with reduced mean per-patient costs. In a multivariate analysis, chemotherapy in the 2 weeks of life remained predictive of increased costs (median increase, $536; P < .0001), whereas access to palliation remained predictive for lower costs (median decrease, $418; P < .0001).CONCLUSIONS Cancer patients who receive aggressive end-of-life care incur 43% higher costs than those managed nonaggressively. Palliative consultation may partially offset these costs and offer resultant savings. Cancer 2015. © 2015 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
    Cancer 05/2015; 121(18). DOI:10.1002/cncr.29485 · 4.89 Impact Factor
  • Anca Prica · Kelvin Chan · Matthew Cheung
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    ABSTRACT: A watch and wait (WW) strategy is the standard of care for patients with asymptomatic advanced-stage follicular lymphoma. Recent data have demonstrated an improvement in the time to progression with rituximab induction (RI) with or without rituximab maintenance (RM) in comparison with a WW strategy wait in such patients. It remains unclear whether this is a cost-effective strategy. A Markov decision analysis model was developed to compare the clinical outcomes, costs, and cost-effectiveness of RI (4 weekly doses) plus RM (12 doses every 2 months), RI (4 weekly doses), and a WW strategy for patients newly diagnosed with low-burden, asymptomatic advanced-stage follicular lymphoma over a lifetime horizon. Baseline probabilities and utilities were derived from a systematic review of published studies, and they were evaluated on a 6-month cycle. A Canadian public health payer's perspective was adopted, and costs were presented in 2012 Canadian dollars. RI was the cheapest strategy. It was less costly at $59,953 versus $67,489 for the RM arm and $75,895 for the WW arm. It was also associated with a slightly lower quality-adjusted life expectancy at 6.16 quality-adjusted life years (QALYs) versus 6.28 QALYs for the RM strategy but was superior to WW (5.71 QALYs). In sensitivity analyses of key variables, this effectiveness was sensitive to the probability of first and second progression in the RI arm, and this indicated relatively neutral effectiveness between the 2 rituximab arms. RI without maintenance for asymptomatic advanced-stage follicular lymphoma is the preferred strategy: it minimizes costs per patient over a lifetime horizon. Cancer 2015. © 2015 American Cancer Society. © 2015 American Cancer Society.
    Cancer 04/2015; 121(15). DOI:10.1002/cncr.29372 · 4.89 Impact Factor
  • 01/2015; 4(2). DOI:10.5430/jha.v4n2p1
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    ABSTRACT: Case 1. Anne is a 23-year-old nursing student who presents with bilateral cervical, left supraclavicular, and left axillary adenopathy. Computed tomography (CT) scan of the thorax reveals a 6-cm anterior mediastinal mass. Biopsy of the left supraclavicular lymph node reveals classical nodular sclerosis Hodgkin lymphoma. A complete blood count is normal and the erythrocyte sedimentation rate (ESR) is 25 mm/h. CT scan of the abdomen/pelvis show normal liver and spleen and no evidence of abdominal lymphadenopathy. You are asked to advise her on the role of radiation therapy in her treatment plan. Case 2. John is a 48-year-old teacher who presents with chest pain following a hockey game. A chest radiograph reveals mediastinal widening, and a contrast-enhancedCT scan shows a 7.5-cm anterior mediastinalmass, with enlarged paratracheal and right hilar lymph nodes. Image-guided core biopsy of the mediastinal mass is diagnostic for classical Hodgkin lymphoma. The hemoglobin is 130 g/L, white blood cell count and platelets are normal, and the ESR is 35 mm/h. John asks you about the role of radiotherapy in the management of his lymphoma.
    Blood 01/2015; 125(11). DOI:10.1182/blood-2014-08-545152 · 10.45 Impact Factor
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    ABSTRACT: Three sequential phase II trials were conducted with different immunotherapy approaches to enhance the outcome of autologous transplant (high-dose therapy and autologous stem cell transplantation (HDT/ASCT)) for recurrent follicular lymphoma. Seventy-three patients were enrolled from 1996 to 2009. Patients received HDT/ASCT combined with (1) interferon-α 3 MU/m2 subcutaneously (SC) three times per week (TIW) for 2 years post-ASCT, (2) rituximab (R) 375 mg/m2 for in vivo purging 3–5 days pre-stem cell collection and 2 × 4 weekly R at 2 and 6 months post-ASCT, respectively, or (3) three infusions of R pre-stem cell collection followed by 6× R weekly and interferon-α 3 MU/m2 SC TIW. Although not statistically significant, progression-free survival (PFS) for patients who received rituximab was 56.4 and 49.1 % at 5 and 10 years compared to 36 and 21 % in those who did not receive rituximab. Molecular relapse post-HDT/ASCT was the strongest predictor of PFS in a multivariate analysis. Molecular relapse was coincident with or preceded clinical relapses in 84 % of patients who relapsed—median of 12 months (range 0–129 months). Adverse events included secondary malignancy, transformation to diffuse large B cell lymphoma, prolonged mostly asymptomatic hypogammaglobulinemia, and pulmonary fibrosis. The long-term toxicity profile must be considered when selecting patients for this treatment.
    Annals of Hematology 01/2015; 94(5). DOI:10.1007/s00277-014-2288-5 · 2.63 Impact Factor
  • Journal of Cancer Therapy 01/2015; 06(01):1-11. DOI:10.4236/jct.2015.61001
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    Douglas A Coyle · Matthew C Cheung · Gerald A Evans
    Medical Decision Making 12/2014; 35(2). DOI:10.1177/0272989X14563082 · 3.24 Impact Factor
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    ABSTRACT: The objective of the present analysis was to determine the publicly funded health care costs associated with the care of breast cancer (bca) patients by disease stage. Incident cases of female invasive bca (2005-2009) were extracted from the Ontario Cancer Registry and linked to administrative datasets from the publicly funded system. The type and use of health care services were stratified by disease stage over the first 2 years after diagnosis. Mean costs and costs by type of clinical resource used in the care of bca patients were compared with costs for a matched control group. The attributable cost for the 2-year time horizon was determined in 2008 Canadian dollars. This cohort study involved 39,655 patients with bca and 190,520 control subjects. The average age in those groups was 61.1 and 60.9 years respectively. Most bca patients were classified as either stage i (34.4%) or stage ii (31.8%). Of the bca cohort, 8% died within the first 2 years after diagnosis. The overall mean cost per bca case from a public payer perspective in the first 2 years after diagnosis was $41,686. Over the 2-year time horizon, the mean cost increased by stage: i, $29,938; ii, $46,893; iii, $65,369; and iv, $66,627. The attributable cost of bca was $31,732. Cost drivers were cancer clinic visits, physician billings, and hospitalizations. Costs of care increased by stage of bca. Cost drivers were cancer clinic visits, physician billings, and hospitalizations. These data will assist planning and decision-making for the use of limited health care resources.
    12/2014; 21(6):281-293. DOI:10.3747/co.21.2143
  • Anna Nikonova · Hany R Guirguis · Rena Buckstein · Matthew C Cheung
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    ABSTRACT: There is a paucity of data on the impact of diagnostic and treatment delays on outcomes in haematological malignancies, particularly in patients with diffuse large B-cell lymphoma (DLBCL). Our database of patients treated for DLBCL between 2002 and 2010 was interrogated. Univariate and multivariate analyses were performed to determine the relationship between sociodemographic or disease-specific variables and delays. Cox Regression analysis was used to discern the impact of delays on survival. Patients (n = 278) waited a median of 4 weeks before seeking medical attention. It took a median of 8 weeks for a non-haematology physician to diagnose DLBCL and refer to a haematologist. A median of 3 weeks elapsed between specialist consultation and chemotherapy initiation. In multivariate logistic regression analysis, bone marrow involvement [odds ratio (OR) = 0·41, P = 0·018], Charlson comorbidity index (OR = 1·42, P = 0·017) and urgent inpatient chemotherapy (OR = 0·40, P = 0·012) were associated with diagnostic delays >6 weeks. Lack of pathological diagnosis at the time of haematology referral was the only factor that independently predicted for treatment delays >4 weeks (OR = 8·25, P < 0·01). Diagnostic or treatment delays did not impact survival or progression-free survival. In conclusion, selected disease and patient-related factors are associated with delays in management of DLBCL, but do not impact outcomes.
    British Journal of Haematology 10/2014; 168(4). DOI:10.1111/bjh.13150 · 4.71 Impact Factor
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    ABSTRACT: Purpose: Although quality improvement (QI) is an integral part of cancer care, there are few QI publications in the medical oncology literature. We examined the prevailing attitudes of medical oncologists toward QI and causes for the low QI publication rate in the medical oncology literature. Methods: Using a modified Dillman method, we distributed a 13-question online survey to medical oncologists across Canada asking about their attitudes toward and involvement in QI and perceived barriers to publishing QI studies. Results: We attained a 43% response rate (143 of 332). Of the responding oncologists, 97% (138) agreed that QI was an important aspect of their practice, although only 49% (70) had participated in QI in the past 5 years. Physicians with administrative responsibility were more likely than clinicians to be involved in QI (P = .008). Most QI participants focused on domains of safety (70%) and patient centeredness (67%). Among QI participants, 72% did not publish their findings, because of lack of time (34%), no identifiable journals (14%), and unfamiliarity with QI methodology (10%). Barriers for QI nonparticipants included uncertainty about how to get involved (45%), lack of time (18%), and limited institutional support or recognition (18%). QI participants had greater awareness of recent practice-changing QI publications compared with nonparticipants (P = .003). Conclusion: Canadian medical oncologists face limitations to participating in and publishing QI initiatives because of lack of knowledge about ongoing initiatives, lack of time, and lack of resources to aid publication. Improving networking opportunities and prioritizing QI at the institutional level can address this need.
    Journal of Oncology Practice 10/2014; 10(6). DOI:10.1200/JOP.2014.001515
  • Matthew C. Cheung · David Barth · Daniel J. Weisbrod · Yulia Lin
    Transfusion 09/2014; 54(12). DOI:10.1111/trf.12808 · 3.23 Impact Factor
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    ABSTRACT: We conducted a systematic review to determine the appropriate use of bortezomib alone or in combination with other agents in patients with multiple myeloma (mm). We searched medline, embase, the Cochrane Library, conference proceedings, and the reference lists of included studies. We analyzed randomized controlled trials and systematic reviews if they involved adult mm patients treated with bortezomib and if they reported on survival, disease control, response, quality of life, or adverse effects. Twenty-six unique studies met the inclusion criteria. For patients with previously untreated mm and for candidates for transplantation, we found a statistically significant benefit in time to progression [hazard ratio (hr): 0.48, p < 0.001; and hr: 0.63, p = 0.006, respectively] and a better response with a bortezomib than with a non-bortezomib regimen (p < 0.001). Progression-free survival was longer with bortezomib and thalidomide than with thalidomide alone (p = 0.01). In non-candidates for transplantation, a significant benefit in overall survival was observed with a bortezomib regimen (hr compared with a non-bortezomib regimen: 0.61; p = 0.008), and in transplantation candidates receiving bortezomib, the response rate was improved after induction (p = 0.004) and after a first transplant (p = 0.016). In relapsed or refractory mm, overall survival (p = 0.03), time to progression (hr: 1.82; p = 0.000004), and progression-free survival (hr: 1.69; p = 0.000026) were significantly improved with bortezomib and pegylated liposomal doxorubicin (compared with bortezomib alone), and bortezomib monotherapy was better than dexamethasone alone (hr: 0.77; p = 0.027). Bortezomib combined with thalidomide and dexamethasone was better than either bortezomib monotherapy or thalidomide with dexamethasone (p < 0.001). In previously untreated or in relapsed or refractory mm patients, bortezomib-based therapy has improved disease control and, in some patients, overall survival.
    08/2014; 21(4):e573-603. DOI:10.3747/co.21.1798
  • Doug Coyle · Matthew C Cheung · Gerald A Evans
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    ABSTRACT: Background. Both ethical and economics concerns have been raised with respect to the funding of drugs for rare diseases. This article reports both the cost-effectiveness of eculizumab for the treatment of paroxysmal nocturnal hemoglobinuria (PNH) and its associated opportunity costs. Methods. Analysis compared eculizumab plus current standard of care v. current standard of care from a publicly funded health care system perspective. A Markov model covered the major consequences of PNH and treatment. Cost-effectiveness was assessed in terms of the incremental cost per life year and per quality-adjusted life year (QALY) gained. Opportunity costs were assessed by the health gains foregone and the alternative uses for the additional resources. Results. Eculizumab is associated with greater life years (1.13), QALYs (2.45), and costs (CAN$5.24 million). The incremental cost per life year and per QALY gained is CAN$4.62 million and CAN$2.13 million, respectively. Based on established thresholds, the opportunity cost of funding eculizumab is 102.3 discounted QALYs per patient funded. Sensitivity and subgroup analysis confirmed the robustness of the results. If the acquisition cost of eculizumab was reduced by 98.5%, it could be considered cost-effective. Limitations. The nature of rare diseases means that data are often sparse for the conduct of economic evaluations. When data were limited, assumptions were made that biased results in favor of eculizumab. Conclusions. This study demonstrates the feasibility of conducting economic evaluations in the context of rare diseases. Eculizumab may provide substantive benefits to patients with PNH in terms of life expectancy and quality of life but at a high incremental cost and a substantial opportunity cost. Decision makers should fully consider the opportunity costs before making positive reimbursement decisions.
    Medical Decision Making 07/2014; 34(8). DOI:10.1177/0272989X14539731 · 3.24 Impact Factor
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    ABSTRACT: Metronomic, low dose chemotherapy may have anti-angiogenic effects and augment the effects of lenalidomide in MDS and CMML. We evaluated the clinical efficacy, tolerability and anti-angiogenic effects of melphalan 2 mg and lenalidomide 10 mg for 21 days/28 in CMML (n = 12) and higher risk MDS (n = 8) patients in a prospective phase II study. The primary endpoint was overall response and secondary endpoints included survival, progression-free survival toxicity and biomarkers of angiogenesis. The median age was 73 years, 55% were pretreated and transfusion dependent. The overall response rate was 3(15%) of 19 evaluable patients but 25% in CMML and 33% in pCMML. Dose reductions and/or delays occurred were common due to myelosuppression. Transient spikes in circulating endothelial cells that declined below baseline were seen in responders and patients with CMML, suggesting anti-angiogenic activity. Conclusions: Lenalidomide and metronomic low dose melphalan demonstrate signals of clinical and possible anti-angiogenic activity in patients with pCMML that require future validation. This trial was registered at under # NCT00744536.
    Leukemia research 07/2014; 38(7). DOI:10.1016/j.leukres.2014.03.022 · 2.35 Impact Factor
  • Leukemia and Lymphoma 05/2014; 56(2):1-9. DOI:10.3109/10428194.2014.927457 · 2.89 Impact Factor
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    Value in Health 05/2014; 17(3):A97. DOI:10.1016/j.jval.2014.03.564 · 3.28 Impact Factor
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    Value in Health 05/2014; 17(3):A79. DOI:10.1016/j.jval.2014.03.464 · 3.28 Impact Factor

Publication Stats

291 Citations
271.82 Total Impact Points


  • 2008–2015
    • Sunnybrook Health Sciences Centre
      • • Division of Medical Oncology and Hematology
      • • Department of Medicine
      Toronto, Ontario, Canada
  • 2007–2015
    • University of Toronto
      • • Division of Rheumatology
      • • Department of Medicine
      Toronto, Ontario, Canada
  • 2006–2009
    • McMaster University
      Hamilton, Ontario, Canada