title: Cost-effectiveness of maintenance pemetrexed in patients with advanced nonsquamous-cell lung cancer from the perspective of the Swiss health care system.
abstract: OBJECTIVE
  A recent randomized study showed switch maintenance with pemetrexed after nonpemetrexed-containing first-line chemotherapy in patients with advanced nonsmall-cell lung cancer to prolong overall survival by 2.8 months. We examined the cost-effectiveness of pemetrexed in this indication, from the perspective of the Swiss health care system, and assessed the influence of the costs of best supportive care (BSC) on overall cost-effectiveness.
  
  
  METHODS
  A Markov model was constructed based on the pemetrexed maintenance study, and the incremental cost-effectiveness ratio (ICER) of adding pemetrexed until disease progression was calculated as cost per quality-adjusted life-year gained. Uncertainties concerning the costs of BSC on the ICER were addressed.
  
  
  RESULTS
  The base case ICER for maintenance therapy with pemetrexed plus BSC compared to BSC alone was €106,202 per quality-adjusted life-year gained. Varying the costs for BSC had a marked effect. Assuming a reduction of the costs for BSC by 25% in the pemetrexed arm resulted in an ICER of €47,531 per quality-adjusted life-year, which is below predefined criteria for cost effectiveness in Switzerland.
  
  
  CONCLUSIONS
  Switch maintenance with pemetrexed in patients with advanced nonsquamous-cell lung cancer after standard first-line chemotherapy is not cost-effective. Uncertainties on the resource use and costs for BSC have a large influence on the cost-effectiveness calculation and should be reported in more detail.
authors.affiliation: Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland. klazien.matter@unibas.ch
authors.forename: Klazien
authors.initials: K
authors.lastname: Matter-Walstra
authors.forename: Markus
authors.initials: M
authors.lastname: Joerger
authors.forename: Ursula
authors.initials: U
authors.lastname: Kühnel
authors.forename: Thomas
authors.initials: T
authors.lastname: Szucs
authors.forename: Bernhard
authors.initials: B
authors.lastname: Pestalozzi
authors.forename: Matthias
authors.initials: M
authors.lastname: Schwenkglenks
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000191:economics*; D000970:Antineoplastic Agents / Q000191:economics; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D004334:Drug Administration Schedule; D005971:Glutamates / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D008390:Markov Chains; D000068437:Pemetrexed; D019057:Quality-Adjusted Life Years; D013557:Switzerland
chemical_list: D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine