title: Cost-effectiveness of second-line chemotherapy for non-small cell lung cancer: an economic, randomized, prospective, multicenter phase III trial comparing docetaxel and pemetrexed: the GFPC 05-06 study.
abstract: BACKGROUND
  There are few data on the cost-effectiveness of second-line chemotherapies for non-small cell lung cancer (NSCLC). The objective of this phase III, randomized, multicenter, prospective study was to compare the cost-effectiveness of docetaxel and pemetrexed, two widely used drugs.
  
  
  METHODS
  We compared, from a payer's perspective, the directs costs and effectiveness of docetaxel (75 mg/m, arm A) and pemetrexed (500 mg/m, arm B) administered every 3 weeks to NSCLC patients who had progressed after first-line platinum-based chemotherapy. Monthly health utilities (based on disease states: responding, stable or progressive, and grade 3/4 toxicities) were derived from the literature. Costs were prospectively assessed.
  
  
  RESULTS
  One hundred fifty patients were enrolled between February 2006 and June 2008. The patients in the docetaxel and pemetrexed arms had similar clinical characteristics and treatment efficacy (respective objective response rates 10.7% and 12%; median progression-free survival times 2.8 and 2.5 months; median survival times 8.0 and 6.4 months, respectively). Grade 3/4 toxicities were significantly less frequent with pemetrexed (52.0% versus 33.3%, p = 0.02). Docetaxel was associated with lower treatment-period costs (€9709 ± €6272 versus €13,436 ± €6508, p < 0.001). Docetaxel had a more favorable cost-utility ratio than pemetrexed. When compared with best supportive care, the cost-utility was €32,652/quality-adjusted life year for docetaxel and €40,980/quality-adjusted life year for pemetrexed.
  
  
  CONCLUSIONS
  Second-line treatment for NSCLC is more cost-effective with docetaxel than with pemetrexed. Both strategies have acceptable cost-effectiveness ratios compared with commonly used and reimbursed regimens for advanced NSCLC.
authors.affiliation: Service de Pathologie Respiratoire, CHU, Limoges. alain.vergnenegre@unilim.fr
authors.forename: Alain
authors.initials: A
authors.lastname: Vergnenegre
authors.forename: Romain
authors.initials: R
authors.lastname: Corre
authors.forename: Henri
authors.initials: H
authors.lastname: Berard
authors.forename: Dominique
authors.initials: D
authors.lastname: Paillotin
authors.forename: Cecile
authors.initials: C
authors.lastname: Dujon
authors.forename: Gilles
authors.initials: G
authors.lastname: Robinet
authors.forename: Jacky
authors.initials: J
authors.lastname: Crequit
authors.forename: Suzanna
authors.initials: S
authors.lastname: Bota
authors.forename: Pascal
authors.initials: P
authors.lastname: Thomas
authors.forename: Christos
authors.initials: C
authors.lastname: Chouaid
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000191:economics / Q000473:pathology; 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 / Q000191:economics* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D000068437:Pemetrexed; D010984:Platinum / Q000009:adverse effects; D011446:Prospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D043823:Taxoids / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D005971:Glutamates; D043823:Taxoids; D000068437:Pemetrexed; D000077143:Docetaxel; D010984:Platinum; D006147:Guanine