Cost-effectiveness of pemetrexed plus cisplatin as first-line therapy for advanced nonsquamous non-small cell lung cancer.
BACKGROUND
To estimate the cost-effectiveness of first-line cisplatin/pemetrexed (Cis/Pem) compared with cisplatin/gemcitabine (Cis/Gem), carboplatin/paclitaxel (Carb/Pac), and carboplatin/paclitaxel/bevacizumab (Carb/Pac/Bev) in patients with advanced non-small cell lung cancer (NSCLC), particularly in those with nonsquamous cell histology (i.e., adenocarcinoma, large cell carcinoma, or histology not otherwise specified).


METHODS
A semi-Markov model was developed to compare the 2-year impact of Cis/Pem to three other first-line regimens from the U.S. payer perspective. Data from the randomized controlled clinical trial of Cis/Pem versus Cis/Gem and a mixed treatment comparison model (no head-to-head data were available for the Cis/Pem to Carb/Pac or Carb/Pac/Bev comparisons) provided clinical inputs. Medicare reimbursement rates were used to determine drug costs. A retrospective claims database analysis was used to obtain estimates of other direct NSCLC-related costs.


RESULTS
In all patients with advanced NSCLC regardless of histologic subtype, using Cis/Pem as first-line chemotherapy led to an incremental cost per life-year gained (LYG) of $104,577 for Cis/Pem to Cis/Gem and $231,291 for Cis/Pem to Carb/Pac. In the prespecified subset of patients with nonsquamous cell histology, the incremental cost per LYG was $83,537 for Cis/Pem to Cis/Gem and $178,613 for Cis/Pem to Carb/Pac. The incremental cost per LYG for Carb/Pac/Bev to Cis/Pem was more than $300,000.


CONCLUSIONS
Compared with commonly used and reimbursed regimens for first-line chemotherapy in advanced NSCLC, Cis/Pem may be considered cost-effective, particularly in patients with nonsquamous cell histology. This analysis emphasizes the importance of histology in identifying the appropriate patient for Cis/Pem first-line chemotherapy.
Klein
Robert
R
Medical Decision Modeling, Indianapolis, Indiana, USA.
Muehlenbein
Catherine
C
Liepa
Astra M
AM
Babineaux
Steve
S
Wielage
Ron
R
Schwartzberg
Lee
L
D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D002945:Cisplatin / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D029721:Drosophila Proteins; D016527:Drug Costs; D004359:Drug Therapy, Combination; D010450:Endopeptidases; D005260:Female; D005500:Follow-Up Studies; D005971:Glutamates / Q000191:economics* / Q000627:therapeutic use; D006147:Guanine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009367:Neoplasm Staging; D000068437:Pemetrexed; D012189:Retrospective Studies; D013940:Thymidylate Synthase / Q000037:antagonists & inhibitors; D014481:United States
D000970:Antineoplastic Agents; D029721:Drosophila Proteins; D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine; D013940:Thymidylate Synthase; D010450:Endopeptidases; C499246:RN-tre protein, Drosophila; D002945:Cisplatin