title: Comparative clinical and economic outcomes of treatments for refractory non-small cell lung cancer (NSCLC).
abstract: BACKGROUND
  Various drug therapies are available for treatment of refractory stage IIIB/IV non-small cell lung cancer (NSCLC), but their comparative economic value is unclear.
  
  
  METHODS
  We developed a decision analytic model to evaluate the incremental costs and quality-adjusted life-years (QALYs) of erlotinib, docetaxel, or pemetrexed in a cohort of refractory advanced stage NSCLC patients 60 years of age from a US payer perspective. Mean progression-free and overall survival were assumed equal for the three treatments based on published clinical trials, from which adverse event rates were also derived. Costs and utilities were obtained from publicly available sources. We performed sensitivity analyses to evaluate uncertainty in the results.
  
  
  RESULTS
  Treatment with erlotinib, docetaxel, and pemetrexed yielded 0.42, 0.41, and 0.41 quality-adjusted life-years (QALYs), respectively. The slightly increased QALYs for erlotinib compared to docetaxel and pemetrexed resulted from less severe treatment complications and oral vs. IV administration. Total costs were US$ 37,000, US$ 39,100 and US$ 43,800 for erlotinib, docetaxel and pemetrexed, respectively. In the probabilistic sensitivity analyses, erlotinib was cost-saving in 65 and 87% of the simulations compared to docetaxel and pemetrexed, respectively, and had improved QALYs and decreased costs or was cost-effective in 42 and 55% of simulations. Estimates of treatment duration were among the most influential parameters in the analyses.
  
  
  CONCLUSIONS
  The results of our analysis suggest treatment of refractory NSCLC with erlotinib is less costly compared with alternative treatments, and suggested improvements in QALYs should be confirmed in controlled clinical trials.
authors.affiliation: Institute for Public Health Genetics, School of Public Health and Community Medicine, University of Washington, Seattle, United States.
authors.forename: Josh J
authors.initials: JJ
authors.lastname: Carlson
authors.forename: Carolina
authors.initials: C
authors.lastname: Reyes
authors.forename: Nina
authors.initials: N
authors.lastname: Oestreicher
authors.forename: Deborah
authors.initials: D
authors.lastname: Lubeck
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
authors.forename: David L
authors.initials: DL
authors.lastname: Veenstra
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000191:economics*; D002986:Clinical Trials as Topic; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents