Cost-effectiveness analysis of pemetrexed versus docetaxel in the second-line treatment of non-small cell lung cancer in Spain: results for the non-squamous histology population.
BACKGROUND
The objective of this study was to conduct a cost-effectiveness evaluation of pemetrexed compared to docetaxel in the treatment of advanced or metastatic non-small cell lung cancer (NSCLC) for patients with predominantly non-squamous histology in the Spanish healthcare setting.


METHODS
A Markov model was designed consisting of stable, responsive, progressive disease and death states. Patients could also experience adverse events as long as they received chemotherapy. Clinical inputs were based on an analysis of a phase III clinical trial that identified a statistically significant improvement in overall survival for non-squamous patients treated with pemetrexed compared with docetaxel. Costs were collected from the Spanish healthcare perspective.


RESULTS
Outcomes of the model included total costs, total quality-adjusted life years (QALYs), total life years gained (LYG) and total progression-free survival (PFS). Mean survival was 1.03 years for the pemetrexed arm and 0.89 years in the docetaxel arm; QALYs were 0.52 compared to 0.42. Per-patient lifetime costs were 34677 euros and 32343 euros, respectively. Incremental cost-effectiveness ratios were 23967 euros per QALY gained and 17225 euros per LYG.


CONCLUSIONS
Pemetrexed as a second-line treatment option for patients with a predominantly non-squamous histology in NSCLC is a cost-effective alternative to docetaxel according to the 30000 euros /QALY threshold commonly accepted in Spain.
Asukai
Yumi
Y
IMS Health, 7 Harewood Avenue, NW1 6JB, London, UK. yasukai@uk.imshealth.com
Valladares
Amparo
A
Camps
Carlos
C
Wood
Eifiona
E
Taipale
Kaisa
K
Arellano
Jorge
J
Cassinello
Alejo
A
Sacristán
José Antonio
JA
Dilla
Tatiana
T
D002277:Carcinoma / Q000378:metabolism*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D045744:Cell Line, Tumor; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D018572:Disease-Free Survival; D000077143:Docetaxel; D005260:Female; 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*; D008297:Male; D008390:Markov Chains; D000068437:Pemetrexed; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013030:Spain; D043823:Taxoids / Q000191:economics* / Q000627:therapeutic use*; D016896:Treatment Outcome
D005971:Glutamates; D043823:Taxoids; D000068437:Pemetrexed; D000077143:Docetaxel; D006147:Guanine