Cost-effectiveness of pemetrexed plus cisplatin as first-line therapy for advanced nonsquamous non-small cell lung cancer.

Abstract

INTRODUCTION:

To estimate the cost-effectiveness of first-line cisplatin/pemetrexed (Cis/Pem) compared with cisplatin/gemcitabine (Cis/Gem), carboplatin/paclitaxel (Carb/Pac), and carboplatin/paclitaxel/bevacizumab (Carb/Pac/Bev) in patients with advanced non-small cell lung cancer (NSCLC), particularly in those with nonsquamous cell histology (i.e., adenocarcinoma, large cell carcinoma, or histology not otherwise specified).

METHODS:

A semi-Markov model was developed to compare the 2-year impact of Cis/Pem to three other first-line regimens from the U.S. payer perspective. Data from the randomized controlled clinical trial of Cis/Pem versus Cis/Gem and a mixed treatment comparison model (no head-to-head data were available for the Cis/Pem to Carb/Pac or Carb/Pac/Bev comparisons) provided clinical inputs. Medicare reimbursement rates were used to determine drug costs. A retrospective claims database analysis was used to obtain estimates of other direct NSCLC-related costs.

RESULTS:

In all patients with advanced NSCLC regardless of histologic subtype, using Cis/Pem as first-line chemotherapy led to an incremental cost per life-year gained (LYG) of $104,577 for Cis/Pem to Cis/Gem and $231,291 for Cis/Pem to Carb/Pac. In the prespecified subset of patients with nonsquamous cell histology, the incremental cost per LYG was $83,537 for Cis/Pem to Cis/Gem and $178,613 for Cis/Pem to Carb/Pac. The incremental cost per LYG for Carb/Pac/Bev to Cis/Pem was more than $300,000.

CONCLUSIONS:

Compared with commonly used and reimbursed regimens for first-line chemotherapy in advanced NSCLC, Cis/Pem may be considered cost-effective, particularly in patients with nonsquamous cell histology. This analysis emphasizes the importance of histology in identifying the appropriate patient for Cis/Pem first-line chemotherapy.

• Authors: Robert Klein, Catherine Muehlenbein, Astra M Liepa, Steve Babineaux, Ron Wielage, Lee Schwartzberg
• Journal: Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer (J Thorac Oncol) Vol. 4 Issue 11 Pg. 1404-14 (Nov 2009) ISSN: 1556-1380 [Electronic] United States
• PMID: 19786904 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Antineoplastic Agents
• Drosophila Proteins
• Glutamates
• Pemetrexed
• Guanine
• Thymidylate Synthase
• Endopeptidases
• RN-tre protein, Drosophila
• Cisplatin

Topics

• Antineoplastic Agents (economics, therapeutic use)
• Carcinoma, Non-Small-Cell Lung (drug therapy, economics, pathology)
• Cisplatin (economics, therapeutic use)
• Cost-Benefit Analysis
• Drosophila Proteins
• Drug Costs
• Drug Therapy, Combination
• Endopeptidases
• Female
• Follow-Up Studies
• Glutamates (economics, therapeutic use)
• Guanine (analogs & derivatives, economics, therapeutic use)
• Humans
• Lung Neoplasms (drug therapy, economics, pathology)
• Male
• Middle Aged
• Models, Economic
• Neoplasm Staging
• Pemetrexed
• Retrospective Studies
• Thymidylate Synthase (antagonists & inhibitors)
• United States