title: Carboplatin plus pemetrexed offers superior cost-effectiveness compared to pemetrexed in patients with advanced non-small cell lung cancer and performance status 2.
abstract: OBJECTIVE
  Pemetrexed plus carboplatin offers survival advantage in first line treatment of advanced lung cancer patients with performance status of 2. We estimated the cost-effectiveness of this combined regimen compared to pemetrexed alone in a Brazilian population.
  
  
  METHODS
  A cost-effectiveness analysis was conducted based on a randomized phase III trial in patients with advanced non-small cell lung cancer (NSCLC) and ECOG performance status of 2 (PS2), comparing doublet regimen pemetrexed plus carboplatin with pemetrexed alone. The perspective adopted was the public health care sector over a three-year period. Direct medical costs and survival time were calculated from patient-level data and utility values were extracted from the literature. Sensitivity analyses were performed to evaluate uncertainties in the results.
  
  
  CONCLUSIONS
  The combined regimen pemetrexed plus carboplatin yielded a gain of 0.16 life year (LY) and 0.12 quality-adjusted life year (QALY) compared to pemetrexed alone. The total cost was 17,674.31 USD for the combined regimen and 15,722.39 USD for pemetrexed alone. The incremental cost-effectiveness ratio (ICER) was $12,016.09 per LY gained and $15,732.05 per QALY gained. The factors with the greatest impact on the ICER are pemetrexed price and the time to progression utility value. The cost-effectiveness acceptability curve showed an upper 90% probability of pemetrexed plus carboplatin being cost-effective with a threshold between two and three GDP per capita. Our study suggests superiority of the combined pemetrexed plus carboplatin regimen in terms of efficacy as well as cost-effectiveness in advanced NSCLC patients with a poor performance status of 2.
authors.affiliation: Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Brazilian Network for Clinical Cancer Research, Brazil. Electronic address: lschluckebier@inca.gov.br.
authors.forename: Luciene
authors.initials: L
authors.lastname: Schluckebier
authors.affiliation: Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.
authors.forename: Osvaldo U
authors.initials: OU
authors.lastname: Garay
authors.affiliation: Instituto Nacional de Cancer, Rio de Janeiro, Brazil.
authors.forename: Mauro
authors.initials: M
authors.lastname: Zukin
authors.affiliation: Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Brazilian Network for Clinical Cancer Research, Brazil; D'or Institute of Research and Education Supported by Fundação do Cancer, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil.
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Ferreira
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D003362:Cost-Benefit Analysis; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D000068437:Pemetrexed / Q000008:administration & dosage / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
chemical_list: D000068437:Pemetrexed; D016190:Carboplatin
keywords: Cost effectiveness; Non-small cell lung cancer; PS2 patients; Pemetrexed