title: Cost-effectiveness of continuation maintenance pemetrexed after cisplatin and pemetrexed chemotherapy for advanced nonsquamous non-small-cell lung cancer: estimates from the perspective of the Chinese health care system.
abstract: BACKGROUND
  Continuation maintenance treatment with pemetrexed is approved by current clinical guidelines as a category 2A recommendation after induction therapy with cisplatin and pemetrexed chemotherapy (CP strategy) for patients with advanced nonsquamous non-small-cell lung cancer (NSCLC). However, the cost-effectiveness of the treatment remains unclear.
  
  
  OBJECTIVE
  We completed a trial-based assessment, from the perspective of the Chinese health care system, of the cost-effectiveness of maintenance pemetrexed treatment after a CP strategy for patients with advanced nonsquamous NSCLC.
  
  
  METHODS
  A Markov model was developed to estimate costs and benefits. It was based on a clinical trial that compared continuation maintenance pemetrexed therapy plus best supportive care (BSC) versus placebo plus BSC after a CP strategy for advanced nonsquamous NSCLC. Sensitivity analyses were conducted to assess the stability of the model.
  
  
  RESULTS
  The model base case analysis suggested that continuation maintenance pemetrexed therapy after a CP strategy would increase benefits in a 1-, 2-, 5-, or 10-year time horizon, with incremental costs of $183,589.06, $126,353.16, $124,766.68, and $124,793.12 per quality-adjusted life-year gained, respectively. The most sensitive influential variable in the cost-effectiveness analysis was the utility of the progression-free survival state, followed by proportion of patients with postdiscontinuation therapy in both arms, proportion of BSC costs for PFS versus progressed survival state, and cost of pemetrexed. Probabilistic sensitivity analysis indicated that the cost-effective probability of adding continuation maintenance pemetrexed therapy to BSC was zero. One-way and probabilistic sensitivity analyses revealed that the Markov model was robust.
  
  
  CONCLUSIONS
  Continuation maintenance of pemetrexed after a CP strategy for patients with advanced nonsquamous NSCLC is not cost-effective based on a recent clinical trial. Decreasing the price or adjusting the dosage of pemetrexed may be a better option for meeting the treatment demands of Chinese patients.
authors: School of Pharmaceutical Sciences, Central South University, Changsha Hunan, People's Republic of China.
authors: Xiaohui
authors: X
authors: Zeng
authors: Liubao
authors: L
authors: Peng
authors: Jianhe
authors: J
authors: Li
authors: Gannong
authors: G
authors: Chen
authors: Chongqing
authors: C
authors: Tan
authors: Siying
authors: S
authors: Wang
authors: Xiaomin
authors: X
authors: Wan
authors: Lihui
authors: L
authors: Ouyang
authors: Ziying
authors: Z
authors: Zhao
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality / Q000473:pathology; D002681:China; D002945:Cisplatin / Q000008:administration & dosage / Q000191:economics; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics*; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D016527:Drug Costs; D005971:Glutamates / Q000008:administration & dosage / Q000191:economics; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality / Q000473:pathology; D008390:Markov Chains; D018803:Models, Economic; D000068437:Pemetrexed; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine; D002945:Cisplatin