Topotecan for relapsed small cell lung cancer: a systematic review and economic evaluation.
BACKGROUND
Topotecan is a relatively new drug for use as a second-line treatment in patients with relapsed small cell lung cancer (SCLC). We performed a systematic review and economic evaluation of topotecan, and consider it here in relation to the NICE end of life criteria.


METHODS
Seventeen bibliographic databases (including Cochrane library, Medline and Embase) were searched from 1990 to February 2009, and experts and manufacturers were consulted, to identify relevant randomised controlled trials (RCTs) which were selected according to prospectively defined criteria. An economic evaluation was undertaken to assess cost effectiveness compared with best supportive care (BSC) in the UK.


RESULTS
Five RCTs were included. The clinical evidence indicates a statistically significant benefit of oral topotecan plus BSC compared to BSC alone for overall survival. Intravenous topotecan was similar in efficacy to both oral topotecan and CAV (cyclophosphamide, doxorubicin and vincristine). In the survival model, oral topotecan plus BSC was associated with an average gain in life expectancy of approximately 4 months, resulting in a gain of 0.183 quality-adjusted life years (QALYs). At an incremental cost of approximately £6200 the incremental cost effectiveness ratio (ICER) is £33,851 per QALY gained.


CONCLUSIONS
Compared with BSC alone, oral topotecan for patients with relapsed SCLC was associated with improved health outcomes but at increased cost. The ICER is at the upper extreme of the range conventionally regarded as cost effective from an NHS decision making perspective. However, this treatment may fall under supplementary guidance for life extending, end of life treatments.
Hartwell
Debbie
D
Southampton Health Technology Assessments Centre, University of Southampton, First Floor Epsilon House, Enterprise Road, Southampton Science Park, Southampton, UK. d.hartwell@soton.ac.uk
Jones
Jeremy
J
Loveman
Emma
E
Harris
Petra
P
Clegg
Andrew
A
Bird
Alex
A
D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis / Q000191:economics; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D055752:Small Cell Lung Carcinoma / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D019772:Topotecan / Q000191:economics / Q000627:therapeutic use*
D000970:Antineoplastic Agents; D019772:Topotecan