A cost-effectiveness analysis of docetaxel in the second-line treatment of non-small cell lung cancer.
BACKGROUND
Whilst lung cancer is the most common form of cancer in England and Wales (annual incidence rate of 50 per 100,000) it does not always receive the policy attention accorded to other types of cancer, such as breast and colorectal. Nevertheless, the burden of lung cancer is significant and the UK NHS Plan for cancer has set out the government's commitment to improving all cancer services. The question faced by the NHS is which interventions are most cost effective in implementing this plan.


OBJECTIVE
To develop a model to assess the economics of second-line treatment of non-small cell lung cancer (NSCLC) from the perspective of the UK NHS, based on the resources and outcomes from the pivotal clinical study comparing docetaxel 75 mg/m(2) with best supportive care (BSC).


METHODS
The area under the survival curve for each treatment was analysed and the difference in mean survival between the docetaxel group and the BSC group was calculated as 3.82 months. Measurable incremental costs for the docetaxel group were largely driven by drug acquisition and administration. These cost drivers, as well as toxicity treatment costs and cost offsets, were varied in the sensitivity analysis. Although the overall timeframe for the model was 2 years, discounting was not applied as the resources and benefits of docetaxel use in this setting are realised relatively immediately.


RESULTS
The base case cost-effectiveness analysis (mean values) reported a cost per life-year gained of 13,863 pounds sterling for docetaxel 75 mg/m(2) (year 2000/2001 values). Sensitivity analysis showed that the number of treatment cycles per patient, which affected total treatment cost, had most influence on the cost per life-year gained in the base case scenario. Using the 95% confidence intervals around the mean number of treatment cycles, the base case cost per life-year gained varied from 10,985 pounds sterling to 16,738 pounds sterling. Using the 95% confidence intervals around the mean difference in survival, to represent best and worst case scenarios, the cost per life-year saved ranged from 10,020 pounds sterling to 32,781 pounds sterling .


CONCLUSIONS
This model suggests, with its underlying assumptions and data, docetaxel 75 mg/m(2) in 3-weekly cycles is a cost-effective second-line treatment, from the perspective of the NHS, for pretreated NSCLC in terms of survival gains made for a reasonable increase in costs.
Holmes
Jeremy
J
PMSI Healthcare, 64 Highgate High Street, London N6 5HX, UK. jholmes@pmsi-consulting.com
Dunlop
David
D
Hemmett
Lindsay
L
Sharplin
Peter
P
Bose
Uday
U
D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D000077143:Docetaxel; D004334:Drug Administration Schedule; D023381:Endpoint Determination; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D018803:Models, Economic; D013222:State Medicine; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome; D006113:United Kingdom
D000972:Antineoplastic Agents, Phytogenic; D043823:Taxoids; D000077143:Docetaxel