Addition of cetuximab to first-line chemotherapy in patients with advanced non-small-cell lung cancer: a cost-utility analysis.
BACKGROUND
Adding cetuximab to standard chemotherapy results in a moderate increase of overall survival in patients with advanced non-small-cell lung cancer (NSCLC), but the cost-effectiveness is unknown.


METHODS
A Markov model was constructed based on the results of the First-Line ErbituX in lung cancer randomized trial, adding cetuximab to cisplatin-vinorelbine first-line chemotherapy in patients with advanced NSCLC. The primary outcome was the incremental cost-effectiveness ratio (ICER) of adding cetuximab, expressed as cost per quality-adjusted life year (QALY) gained, and relative to a willingness-to-pay threshold of €60 000/QALY. The impact of cetuximab intermittent dosing schedules on the ICER was also evaluated.


RESULTS
Adding cetuximab to standard chemotherapy leads to a gain of 0.07 QALYs per patient at an additional cost of €26 088. The ICER for adding cetuximab to chemotherapy was €376 205 per QALY gained. Intermittent cetuximab dosing schedules resulted in ICERs per QALY gained between €31 300 and €83 100, under the assumption of equal efficacy.


CONCLUSIONS
From a health economic perspective, the addition of cetuximab to standard first-line chemotherapy in patients with epidermal growth factor receptor-expressing advanced NSCLC cannot be recommended to date, due to a high ICER compared with other health care interventions. Treatment schedules resulting in more favorable cost-utility ratios should be evaluated.
Joerger
M
M
Department of Oncology and Hematology, Cantonal Hospital, St Gallen. Electronic address: markus.joerger@kssg.ch.
Matter-Walstra
K
K
Institute of Pharmaceutical Medicine, University of Basel, Basel.
Früh
M
M
Department of Oncology and Hematology, Cantonal Hospital, St Gallen.
Kühnel
U
U
Swiss Group for Clinical Cancer Research, Bern.
Szucs
T
T
Institute of Pharmaceutical Medicine, University of Basel, Basel.
Pestalozzi
B
B
Department of Medical Oncology, University Hospital, Zurich, Switzerland.
Schwenkglenks
M
M
Institute of Pharmaceutical Medicine, University of Basel, Basel.
D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000191:economics; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D000068818:Cetuximab; D002945:Cisplatin / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D008390:Markov Chains; D009010:Monte Carlo Method; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D017211:Treatment Failure; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D014747:Vinblastine; D000068818:Cetuximab; D002945:Cisplatin; D000077235:Vinorelbine