Economic evaluation in a randomized phase III clinical trial comparing gemcitabine/cisplatin and etoposide/cisplatin in non-small cell lung cancer.

Abstract

INTRODUCTION:

Information on the relative cost-effectiveness of treatments for cancer is being increasingly sought as pressure on health care resources increases. The objective of this study was to assess the cost-effectiveness of gemcitabine/cisplatin (GC) versus cisplatin/etoposide (CE) in patients with advanced non-small cell lung cancer (NSCLC), using resource utilization data collected in conjunction with the first randomized clinical trial comparing both combinations.

METHODS:

Efficacy and medical care resource utilization data were collected prospectively in an open-label, multicenter, randomized, comparative, phase III trial conducted in Spain which compared gemcitabine/cisplatin and cisplatin/etoposide in 135 chemonaive patients with Stage IIIB or IV NSCLC. There were no differences between both regimens when survival was used as primary end-point, so a cost-minimization analysis was used to compare them. In addition, cost-effectiveness analyses were conducted when percentage of responses and time to progression were used as secondary end-points.

RESULTS:

There were no differences between both regimens when survival was selected as the efficacy end-point. Despite the higher chemotherapy cost of GC when compared to CE, there were no differences in total direct costs (584523 pts for GC and 589630 pts for CE; P=NS) between both regimens. Potential savings with GC were mainly associated with a decrease in hospitalization rate. There were differences in favor of GC when response rate (40.6% for GC and 21.9% for CE; P<0.05) and time to disease progression (8.7 months for GC and 7.2 months for CE; P<0. 05) were used as clinical end-points. GC presented a favorable cost-effectiveness profile when compared to CE.

CONCLUSIONS:

This prospective economic evaluation conducted alongside a clinical trial offers valuable preliminary information on the potential efficiency of the combination gemcitabine-cisplatin in NSCLC. Future assessments based on larger clinical trials focused on survival and naturalistic economic studies conducted in real clinical practice settings are necessary to confirm these findings.

• Authors: J A Sacristán, T Kennedy-Martin, R Rosell, F Cardenal, A Antón, M Lomas, V Alberola, B Massuti, A Carrato, M Minshall
• Journal: Lung cancer (Amsterdam, Netherlands) (Lung Cancer) Vol. 28 Issue 2 Pg. 97-107 (May 2000) ISSN: 0169-5002 [Print] Ireland
• PMID: 10717327 (Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Deoxycytidine
• Etoposide
• Cisplatin
• Gemcitabine

Topics

• Aged
• Antineoplastic Combined Chemotherapy Protocols (economics, therapeutic use)
• Carcinoma, Non-Small-Cell Lung (drug therapy, economics)
• Cisplatin (administration & dosage)
• Clinical Trials, Phase III as Topic (economics)
• Cost-Benefit Analysis
• Costs and Cost Analysis
• Deoxycytidine (administration & dosage, analogs & derivatives)
• Etoposide (administration & dosage)
• Female
• Health Care Costs (statistics & numerical data)
• Humans
• Lung Neoplasms (drug therapy, economics)
• Male
• Middle Aged
• Prospective Studies
• Randomized Controlled Trials as Topic (economics)
• Gemcitabine