title: Costs and clinical outcomes among patients with second-line non-small cell lung cancer in the outpatient community setting.
abstract: BACKGROUND
  A comparison of clinical and economic outcomes among patients receiving second-line monotherapy with erlotinib, docetaxel, and pemetrexed for non-small cell lung cancer was conducted using a large network of outpatient community clinics.
  
  
  METHODS
  We identified 610 patients with advanced non-small cell lung cancer who received 2L treatment from July 1, 2006, to June 30, 2008, and were followed up through July 1, 2009, to evaluate progression-free survival (PFS), overall survival (OS), costs, and health resource utilization. Cox proportional hazards regression were used to compare PFS and OS across treatment cohorts. Economic outcomes were calculated per patient per month (PPPM) during a 12-month follow-up period.
  
  
  RESULTS
  There were 73 patients who received erlotinib, 87 received docetaxel, and 450 received pemetrexed. The median age was 67 years, and 55% were men. No significant differences in stage, baseline performance status, hemoglobin level, or body mass index were observed by treatment. The median OS was 132 days for docetaxel, 132 days for pemetrexed, and 155 days for erlotinib (p = 0.39). Adjusting for age, gender, stage, performance status, and hemoglobin level, there was no significant association between treatment type and OS (p = 0.36) or PFS (p = 0.26). Relative to pemetrexed, total adjusted costs PPPM was $1579 lower for docetaxel and $1584 lower for erlotinib (p < 0.05). Outpatient visits, laboratory procedures, and acute care visits were also less frequent with erlotinib relative to pemetrexed (-2.6 PPPM, p < 0.05).
  
  
  CONCLUSIONS
  We observed no significant differences in OS and PFS between patients receiving erlotinib, docetaxel, and pemetrexed. Nevertheless, erlotinib and docetaxel were associated with a statistically significant lower costs and resource use relative to pemetrexed.
authors: US Oncology, The Woodlands, Texas 75426, USA. Eric.Nadler@oncologytoday.com
authors: Eric
authors: E
authors: Nadler
authors: Michael
authors: M
authors: Forsyth
authors: Sacha
authors: S
authors: Satram-Hoang
authors: Carolina
authors: C
authors: Reyes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000191:economics*; D019411:Clinical Laboratory Techniques; D018572:Disease-Free Survival; D000077143:Docetaxel; D000069347:Erlotinib Hydrochloride; D005260:Female; D005971:Glutamates / Q000191:economics / Q000627:therapeutic use; D006147:Guanine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D000068437:Pemetrexed; D016016:Proportional Hazards Models; D047428:Protein Kinase Inhibitors / Q000191:economics / Q000627:therapeutic use; D011799:Quinazolines / Q000191:economics / Q000627:therapeutic use; D043823:Taxoids / Q000191:economics / Q000627:therapeutic use; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D005971:Glutamates; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D043823:Taxoids; D000068437:Pemetrexed; D000077143:Docetaxel; D006147:Guanine; D000069347:Erlotinib Hydrochloride