title: A cross-market cost comparison of erlotinib versus pemetrexed for first-line maintenance treatment of patients with locally advanced or metastatic non-small-cell lung cancer.
abstract: Erlotinib and pemetrexed were approved by the European Medicines Agency for first-line maintenance treatment of patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) to prolong overall survival after first-line therapy. An adjusted, matched, indirect comparison of erlotinib and pemetrexed suggested that survival benefits were not statistically significantly different between treatments. We conducted a cost-comparison analysis of erlotinib versus pemetrexed in first-line maintenance treatment of locally advanced or metastatic, non-squamous NSCLC in France, Germany, Italy and Spain, performed from the perspective of national health-care decision-makers or purchasers. The analysis was limited to direct costs and comprised drug-acquisition costs, administration costs and costs of treating adverse events (AEs). A one-way sensitivity analysis on administration, acquisition and AE costs was also performed. Total monthly per-patient treatment costs for erlotinib in France, Germany, Italy and Spain were €2140, €2732, €1518 and €2048, respectively, and for pemetrexed €3453, €5534, €2921 and €3164, respectively. AE cost was greater for pemetrexed in all countries, as was administration cost. As an oral treatment, erlotinib is not associated with any administration costs, except in Germany, where the cost is lower than for pemetrexed. The sensitivity analysis showed acquisition costs to be the main driver of total monthly per-patient costs. Erlotinib appears to be a cost-saving treatment alternative to pemetrexed, producing comparable survival benefits, based on an indirect comparison, at a lower cost.
authors.affiliation: Ars Accessus Medica, Dorpsstraat 75, NL 1546 LG Jisp, Amsterdam, The Netherlands. marknuijten@planet.nl
authors.forename: Mark J C
authors.initials: MJ
authors.lastname: Nuijten
authors.forename: Javier
authors.initials: J
authors.lastname: de Castro Carpeño
authors.forename: Christos
authors.initials: C
authors.lastname: Chouaid
authors.forename: Alain
authors.initials: A
authors.lastname: Vergnenègre
authors.forename: Francesco
authors.initials: F
authors.lastname: Grossi
authors.forename: Helge
authors.initials: H
authors.lastname: Bischoff
authors.forename: David
authors.initials: D
authors.lastname: Heigener
authors.forename: Stefan
authors.initials: S
authors.lastname: Walzer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000191:economics / Q000473:pathology*; D016527:Drug Costs; D000069347:Erlotinib Hydrochloride; D005260:Female; D005602:France; D005858:Germany; D005971:Glutamates / Q000191:economics* / Q000627:therapeutic use; D006147:Guanine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D007558:Italy; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000473:pathology*; D060046:Maintenance Chemotherapy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D000068437:Pemetrexed; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011799:Quinazolines / Q000191:economics* / Q000627:therapeutic use; D013030:Spain
chemical_list: D000970:Antineoplastic Agents; D005971:Glutamates; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000068437:Pemetrexed; D006147:Guanine; D000069347:Erlotinib Hydrochloride