title: Raltitrexed plus cisplatin is cost-effective compared with pemetrexed plus cisplatin in patients with malignant pleural mesothelioma.
abstract: BACKGROUND
  The National Institute for Health and Clinical Excellence (NICE) has previously recommended pemetrexed plus cisplatin for the treatment of patients with advanced malignant pleural mesothelioma (MPM) and WHO performance status 0-1. Subsequent to this appraisal, randomised controlled trial (RCT) data for raltitrexed plus cisplatin and comparing chemotherapy to active symptom control (ASC) has become available, allowing a more complete analysis of the comparative efficacy and cost-effectiveness of first-line chemotherapy in MPM.
  
  
  METHODS
  An adjusted indirect comparison is used to estimate the relative efficacy of raltitrexed plus cisplatin and pemetrexed plus cisplatin. A cost-effectiveness model is used to assess the lifetime costs and health outcomes associated with these comparators and ASC. Patient level data from the EORTC 08983 trial are used to estimate baseline progression and survival rates. Relative treatment effects are taken from RCTs; cost and utility data from the literature.
  
  
  RESULTS
  Raltitrexed plus cisplatin and pemetrexed plus cisplatin were not found to be statistically significantly different with respect to overall response, progression free survival or overall survival. The cost-effectiveness analysis found raltitrexed plus cisplatin to be cost-effective at a cost per quality adjusted life year of £13,454 compared to cisplatin and £27,360 compared to ASC. Pemetrexed plus cisplatin is dominated by raltitrexed plus cisplatin as the raltitrexed combination offers marginally higher quality adjusted life years (QALYs) and life years (LYs) at a substantially lower total cost.
  
  
  CONCLUSIONS
  Raltitrexed plus cisplatin is a cost-effective first-line treatment for MPM. This conclusion was maintained across a number of sensitivity analyses.
authors.affiliation: Oxford Outcomes, Oxford, UK. beth.woods@oxfordoutcomes.com
authors.forename: Beth
authors.initials: B
authors.lastname: Woods
authors.forename: Noman
authors.initials: N
authors.lastname: Paracha
authors.forename: David A
authors.initials: DA
authors.lastname: Scott
authors.forename: Nicholas
authors.initials: N
authors.lastname: Thatcher
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D005971:Glutamates / Q000008:administration & dosage; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D017048:Health Care Costs; D006801:Humans; D008654:Mesothelioma / Q000188:drug therapy* / Q000401:mortality; D000068437:Pemetrexed; D010997:Pleural Neoplasms / Q000188:drug therapy* / Q000401:mortality; D019057:Quality-Adjusted Life Years; D011799:Quinazolines / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D013876:Thiophenes / Q000008:administration & dosage
chemical_list: D005971:Glutamates; D011799:Quinazolines; D013876:Thiophenes; D000068437:Pemetrexed; D006147:Guanine; C068874:raltitrexed; D002945:Cisplatin