title: Treatment patterns and cost-effectiveness of first line treatment of advanced non-squamous non-small cell lung cancer in Medicare patients.
abstract: OBJECTIVE
  To assess the cost-effectiveness of first-line pemetrexed/platinum and other commonly administered regimens in a representative US elderly population with advanced non-squamous non-small cell lung cancer (NSCLC).
  
  
  METHODS
  This study utilized the Surveillance Epidemiology and End Results (SEER) cancer registry linked to Medicare claims records. The study population included all SEER-Medicare patients diagnosed in 2008-2009 with advanced non-squamous NSCLC (stages IIIB-IV) as their only primary cancer and who started chemotherapy within 90 days of diagnosis. The study evaluated the four most commonly observed first-line regimens: paclitaxel/carboplatin, platinum monotherapy, pemetrexed/platinum, and paclitaxel/carboplatin/bevacizumab. Overall survival and total healthcare cost comparisons as well as incremental cost-effectiveness ratios (ICERs) were calculated for pemetrexed/platinum vs each of the other three. Unstratified analyses and analyses stratified by initial disease stage were conducted.
  
  
  RESULTS
  The final study population consisted of 2,461 patients. Greater administrative censorship of pemetrexed recipients at the end of the study period disproportionately reduced the observed mean survival for pemetrexed/platinum recipients. The disease stage-stratified ICER analysis found that the pemetrexed/platinum incurred total Medicare costs of $536,424 and $283,560 per observed additional year of life relative to platinum monotherapy and paclitaxel/carboplatin, respectively. The pemetrexed/platinum vs triplet comparator analysis indicated that pemetrexed/platinum was associated with considerably lower total Medicare costs, with no appreciable survival difference.
  
  
  CONCLUSIONS
  Limitations included differential censorship of the study regimen recipients and differential administration of radiotherapy.
  
  
  CONCLUSIONS
  Pemetrexed/platinum yielded either improved survival at increased cost or similar survival at reduced cost relative to comparator regimens in the treatment of advanced non-squamous NSCLC. Limitations in the study methodology suggest that the observed pemetrexed survival benefit was likely conservative.
authors: a JEN Associates , Cambridge , MA , USA.
authors: Daniel M
authors: DM
authors: Gilden
authors: a JEN Associates , Cambridge , MA , USA.
authors: Joanna M
authors: JM
authors: Kubisiak
authors: b Eli Lilly and Company , Indianapolis , IN , USA.
authors: Gerhardt M
authors: GM
authors: Pohl
authors: b Eli Lilly and Company , Indianapolis , IN , USA.
authors: Daniel E
authors: DE
authors: Ball
authors: a JEN Associates , Cambridge , MA , USA.
authors: David E
authors: DE
authors: Gilden
authors: b Eli Lilly and Company , Indianapolis , IN , USA.
authors: William J
authors: WJ
authors: John
authors: b Eli Lilly and Company , Indianapolis , IN , USA.
authors: Stewart
authors: S
authors: Wetmore
authors: b Eli Lilly and Company , Indianapolis , IN , USA.
authors: Katherine B
authors: KB
authors: Winfree
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000191:economics*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D015233:Models, Statistical; D010818:Practice Patterns, Physicians'; D012042:Registries; D018426:SEER Program; D014481:United States
chemical_list: D000970:Antineoplastic Agents
keywords: Bootstrapping; Care costs; Chemotherapy; Cost-effectiveness; Lung cancer; Overall survival