An estimate of the cost effectiveness of gemcitabine in stage IV non-small cell lung cancer.
Statistics Canada (Ottawa, Canada) is developing a population health model (POHEM) that simulates the health and common illnesses of Canadians. The POHEM incorporates a model of lung cancer management based on Canadian practice, which has been used to estimate the total direct care costs of treating all lung cancer cases diagnosed in Canada in 1988. One of the potential uses of the POHEM is to evaluate the cost and cost effectiveness of new therapeutic interventions as they are introduced into practice. Gemcitabine, a new nucleoside analog with a broad spectrum of antitumor activity, has been evaluated in the model and estimates have been made of its cost effectiveness in the management of lung cancer over a range of drug costs per treatment cycle ($Cdn 800 to $Cdn 1,800). The survival of stage IV non-small cell lung cancer (NSCLC) patients treated on an international trial of gemcitabine (E018) was used to estimate the potential survival gain relative to the survival of stage IV NSCLC patients managed with best supportive care on a randomized trial conducted by the National Cancer Institute of Canada. Sensitivity analyses were performed assuming that the survival benefit was 25% and 50% less than that reported in the E018 trial. Based on the apparent survival advantage of the E018 trial, the cost per life-year gained ranged from $Cdn 1,609 to $Cdn 9,529 depending on the cost per treatment cycle. At the greatest cost per cycle ($Cdn 1,800) and with survival reduced by 50% as compared with the E018 result, the cost per life-year gained was estimated to be $Cdn 16,230. From these estimates of direct care costs in the Canadian health care system, gemcitabine appears to be a cost-effective intervention for advanced NSCLC.
Evans
W K
WK
University of Ottawa, Ontario, Canada.
D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D003362:Cost-Benefit Analysis; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D009367:Neoplasm Staging; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine