title: Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504).
abstract: BACKGROUND
  The median age of newly diagnosed patients with non-small cell lung cancer (NSCLC) is 67 years, and one-third of patients are older than 75 years. Elderly patients are more vulnerable to the adverse effects of chemotherapy, and targeted therapy might thus be a relevant alternative. The objective of this study was to assess the cost-effectiveness of erlotinib followed by chemotherapy after progression, compared to the reverse strategy, in fit elderly patients with advanced NSCLC participating in a prospective randomized phase 2 trial (GFPC0504).
  
  
  METHODS
  Outcomes (PFS and overall survival) and costs (limited to direct medical costs, from the third-party payer perspective) were prospectively collected until second progression. Costs after progression and health utilities (based on disease states and grade 3-4 toxicities) were derived from the literature.
  
  
  RESULTS
  Median overall survival, QALY and total costs for the erlotinib-first strategy were respectively 7.1 months, 0.51 and 27 734 €, compared to 9.4 months, 0.52 and 31 688 € for the chemotherapy-first strategy. The Monte Carlo simulation demonstrates that the two strategies do not differ statistically.
  
  
  CONCLUSIONS
  In terms of cost effectiveness, in fit elderly patients with NSCLC, erlotinib followed by chemotherapy compares well with the reverse strategy.
authors: AP-HP Hôpital St-Antoine, AP-HP, UMPC, Paris, France. Christos.chouaid@sat.aphp.fr
authors: Christos
authors: C
authors: Chouaid
authors: Hervé
authors: H
authors: Le Caer
authors: Chrystelle
authors: C
authors: Locher
authors: Cecile
authors: C
authors: Dujon
authors: Pascal
authors: P
authors: Thomas
authors: Jean Bernard
authors: JB
authors: Auliac
authors: Isabelle
authors: I
authors: Monnet
authors: Alain
authors: A
authors: Vergnenegre
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000191:economics*; D003362:Cost-Benefit Analysis; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018450:Disease Progression; D000077143:Docetaxel; D000069347:Erlotinib Hydrochloride; D005602:France; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics*; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D011446:Prospective Studies; D011799:Quinazolines / Q000191:economics / Q000627:therapeutic use*; D043823:Taxoids / Q000008:administration & dosage; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D043823:Taxoids; D003841:Deoxycytidine; D000077143:Docetaxel; D000069347:Erlotinib Hydrochloride; D000093542:Gemcitabine