title: Cost-utility analysis of maintenance therapy with gemcitabine or erlotinib vs observation with predefined second-line treatment after cisplatin-gemcitabine induction chemotherapy for advanced NSCLC: IFCT-GFPC 0502-Eco phase III study.
abstract: BACKGROUND
  The IFCT-GFPC 0502 phase III study reported prolongation of progression-free survival with gemcitabine or erlotinib maintenance vs. observation after cisplatin-gemcitabine induction chemotherapy for advanced non-small-cell lung cancer (NSCLC). This analysis was undertaken to assess the incremental cost-effectiveness ratio (ICER) of these strategies for the global population and pre-specified subgroups.
  
  
  METHODS
  A cost-utility analysis evaluated the ICER of gemcitabine or erlotinib maintenance therapy vs. observation, from randomization until the end of follow-up. Direct medical costs (including drugs, hospitalization, follow-up examinations, second-line treatments and palliative care) were prospectively collected per patient during the trial, until death, from the primary health-insurance provider's perspective. Utility data were extracted from literature. Sensitivity analyses were conducted.
  
  
  RESULTS
  The ICERs for gemcitabine or erlotinib maintenance therapy were respectively 76,625 and 184,733 euros per quality-adjusted life year (QALY). Gemcitabine continuation maintenance therapy had a favourable ICER in patients with PS = 0 (52,213 €/QALY), in responders to induction chemotherapy (64,296 €/QALY), regardless of histology (adenocarcinoma, 62,292 €/QALY, non adenocarcinoma, 83,291 €/QALY). Erlotinib maintenance showed a favourable ICER in patients with PS = 0 (94,908 €/QALY), in patients with adenocarcinoma (97,160 €/QALY) and in patient with objective response to induction (101,186 €/QALY), but it is not cost-effective in patients with PS =1, in patients with non-adenocarcinoma or with stable disease after induction chemotherapy.
  
  
  CONCLUSIONS
  Gemcitabine- or erlotinib-maintenance therapy had ICERs that varied as a function of histology, PS and response to first-line chemotherapy.
authors.affiliation: Études et Recherche en Économie de la Santé, Service de Biostatistique et d'Epidémiologie, Institut Gustave Roussy, 114, rue Edouard-Vaillant, 94805 Villejuif, Cedex, France. isabelle.borget@igr.fr.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Borget
authors.forename: Maurice
authors.initials: M
authors.lastname: Pérol
authors.forename: David
authors.initials: D
authors.lastname: Pérol
authors.forename: Armelle
authors.initials: A
authors.lastname: Lavolé
authors.forename: Laurent
authors.initials: L
authors.lastname: Greillier
authors.forename: Pascal
authors.initials: P
authors.lastname: Dô
authors.forename: Virginie
authors.initials: V
authors.lastname: Westeel
authors.forename: Jacky
authors.initials: J
authors.lastname: Crequit
authors.forename: Hervé
authors.initials: H
authors.lastname: Léna
authors.forename: Isabelle
authors.initials: I
authors.lastname: Monnet
authors.forename: Hervé
authors.initials: H
authors.lastname: Le Caer
authors.forename: Pierre
authors.initials: P
authors.lastname: Fournel
authors.forename: Lionel
authors.initials: L
authors.lastname: Falchero
authors.forename: Michel
authors.initials: M
authors.lastname: Poudenx
authors.forename: Fabien
authors.initials: F
authors.lastname: Vaylet
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chabaud
authors.forename: Alain
authors.initials: A
authors.lastname: Vergnenegre
authors.forename: Gérard
authors.initials: G
authors.lastname: Zalcman
authors.forename: Christos
authors.initials: C
authors.lastname: Chouaïd
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000191:economics; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000191:economics; D002945:Cisplatin / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D000069347:Erlotinib Hydrochloride; D005260:Female; D017048:Health Care Costs; D006801:Humans; D060828:Induction Chemotherapy / Q000191:economics*; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics; D060046:Maintenance Chemotherapy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D011799:Quinazolines / Q000008:administration & dosage / Q000191:economics; D016019:Survival Analysis; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D003841:Deoxycytidine; D000069347:Erlotinib Hydrochloride; D002945:Cisplatin; D000093542:Gemcitabine