title: Pharmacoeconomic analysis of consolidation therapy with pemetrexed after first-line chemotherapy for non-small cell lung cancer.
abstract: Prolongation of progression-free survival and overall survival have been reported with consolidation therapy after first-line chemotherapy in non-small cell lung cancer, but only a few pharmacoeconomic analyses have been performed. We performed a pharmacoeconomic analysis to assess the cost-effectiveness of consolidation therapy with pemetrexed compared with non-consolidation therapy. We developed a Markov model to evaluate the incremental cost-effectiveness ratio (ICER) of consolidation therapy with pemetrexed compared with non-consolidation therapy based on previous reports. We analyzed all histology groups together, and individually analyzed non-squamous cell carcinoma, in which pemetrexed has been shown to be more effective, and squamous cell carcinoma, in which pemetrexed has been shown to be less effective. We conducted a Monte-Carlo simulation to assess the uncertainty for our analysis model and the willingness to pay using thresholds. The ICER for consolidation therapy with pemetrexed was about US$ 109,024/life years gained (LYG) (JPY 12.5 million/LYG) and US$ 203,022/quality-adjusted life years (QALY) (JPY 23.3 million/QALY) for all histology. For non-squamous cell carcinoma, respective values were US$ 80,563/LYG (JPY 9.3 million/LYG) and US$ 150,115/QALY (JPY 17.3 million/QALY). Both % of probability at a threshold of JPY 5.0 million (US$ 43,478) for all histology and non-squamous cell carcinoma were less than 0.1%. This result indicates that it is difficult to use consolidation therapy as the standard of care in Japan while being covered by general medical insurance.
authors.affiliation: Department of Health Science Policies, Tokyo Medical and Dental University, Tokyo, Japan. sph53c29@ivy.ocn.ne.jp
authors.forename: Takanori
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Takashi
authors.initials: T
authors.lastname: Fukuda
authors.forename: Masashi
authors.initials: M
authors.lastname: Furuiye
authors.forename: Koichi
authors.initials: K
authors.lastname: Kawabuchi
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics* / Q000473:pathology / Q000503:physiopathology; D004358:Drug Therapy; D017850:Economics, Pharmaceutical; D005260:Female; D005971:Glutamates; D006147:Guanine / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D008875:Middle Aged; D000068437:Pemetrexed; D016019:Survival Analysis
chemical_list: D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine