title: Economic analysis of a randomized phase III trial of gemcitabine plus vinorelbine compared with cisplatin plus vinorelbine or cisplatin plus gemcitabine for advanced non-small-cell lung cancer (Italian GEMVIN3/NCIC CTG BR14 trial).
abstract: OBJECTIVE
  Non-platinum-based chemotherapy is a potential alternative to platinum doublet therapy for advanced non-small cell lung cancer in selected patients. We determined the cost-effectiveness of gemcitabine/vinorelbine (GEMVIN), versus cisplatin/gemcitabine (PG) or cisplatin/vinorelbine (PV), from a government payer perspective.
  
  
  METHODS
  Results from a randomized trial of GEMVIN versus PG or PV demonstrated no significant difference in global quality of life (primary endpoint) or overall survival between regimens, but superior progression-free survival for platinum-based regimens. A cost analysis was conducted using direct medical costs of treatment, grade 3 or 4 toxicity management, and investigations for the mean number of cycles per study arm. Costs were calculated using Canadian dollars in 2005, and then in 2013 after drug patent expiry.
  
  
  RESULTS
  In 2005, GEMVIN was the most expensive regimen ($6868), and PV the least expensive ($4650), with an incremental cost of GEMVIN over PV of $2218. Diagnostic and administration costs did not differ significantly among regimens; GEMVIN had the lowest toxicity costs. The principal cost driver in 2005 was the cost of chemotherapy. In 2013, toxicity and administration costs emerged as major drivers; GEMVIN was less costly than PV and PG, (cost savings of $413 over PV).
  
  
  CONCLUSIONS
  Despite similar outcomes, GEMVIN was more expensive than PV or PG in 2005 because of higher chemotherapy costs. By 2013, after chemotherapy drug patent expiry, GEMVIN became the least costly regimen. Economic considerations in oncology change over time, and should be revisited in policy decisions based on cost.
authors: NCIC Clinical Trials Group, 10 Stuart Street, Kingston, Ontario, K7L 3N6, Canada. Electronic address: nreaume@ottawahospital.on.ca.
authors: M Neil
authors: MN
authors: Reaume
authors: Natasha B
authors: NB
authors: Leighl
authors: Nicole
authors: N
authors: Mittmann
authors: Doug
authors: D
authors: Coyle
authors: Vera
authors: V
authors: Hirsh
authors: Lesley
authors: L
authors: Seymour
authors: Dongsheng
authors: D
authors: Tu
authors: Frances A
authors: FA
authors: Shepherd
authors: Barbara
authors: B
authors: Graham
authors: Cesare
authors: C
authors: Gridelli
authors: Francesco
authors: F
authors: Perrone
authors: Massimo
authors: M
authors: Di Maio
authors: Penelope A
authors: PA
authors: Bradbury
authors: William K
authors: WK
authors: Evans
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D002945:Cisplatin / Q000008:administration & dosage; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D014747:Vinblastine; D002945:Cisplatin; D000077235:Vinorelbine; D000093542:Gemcitabine
keywords: Cost consequence; Economic analysis; Non-platinum doublet; Non-small cell lung cancer; Platinum doublet