Cost-effectiveness of pemetrexed plus cisplatin: malignant pleural mesothelioma treatment in UK clinical practice.
OBJECTIVE
Findings from the largest randomized phase III trial in patients with unresectable malignant pleural mesothelioma (EMPHACIS study; n = 448) were used to examine the cost-effectiveness of pemetrexed plus cisplatin therapy versus cisplatin monotherapy in patients with the disease. The cost-effectiveness of pemetrexed/cisplatin versus alternative treatments was also examined.


METHODS
Two cost-effectiveness analyses were designed to model best survival outcome over time for a number of patient cohorts. First, trial-based patient-level data were utilized and resource use was costed for the study arm and comparator. A second cost-effectiveness analysis then compared the mean costs and outcomes associated with pemetrexed/cisplatin with the most commonly used (unlicensed) regimens in the United Kingdom-mitomycin-C, vinblastine, and cisplatin (MVP); vinorelbine; and active symptom control-using trial-based data and data extrapolated from a review of the literature.


RESULTS
The total pemetrexed/cisplatin cost per patient varied between pound8779 and pound9020 for all cohorts studied in model 1. Average life-years gained per patient were between 0.20 and 0.28. Quality-adjusted life-years, based on mean and median survival, ranged from 0.13 to 0.31. Incremental cost per life-year gained and quality-adjusted life-year ratios, using both mean and median survival, ranged from pound20,475 to pound68,598. The second cost-effectiveness analysis resulted in ratios ranging from pound14,595 to pound32,066.


CONCLUSIONS
Pemetrexed/cisplatin demonstrated acceptable cost-effectiveness when compared with cisplatin monotherapy and alternative treatments commonly used in UK clinical practice.
Cordony
Anna
A
M-TAG Pty Ltd, A Unit of IMS Health, St Leonards, NSW, Australia. acordony@au.imshealth.com
Le Reun
Corinne
C
Smala
Antje
A
Symanowski
James T
JT
Watkins
Jessamy
J
D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005971:Glutamates / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008654:Mesothelioma / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D016685:Mitomycin; D000068437:Pemetrexed; D010865:Pilot Projects; D010997:Pleural Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D006113:United Kingdom; D014747:Vinblastine / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use
D000964:Antimetabolites, Antineoplastic; D005971:Glutamates; D000068437:Pemetrexed; D016685:Mitomycin; D014747:Vinblastine; D006147:Guanine; D002945:Cisplatin