title: Cost-effectiveness of pemetrexed in combination with cisplatin as first line treatment for patients with advanced non-squamous non-small-cell lung cancer in Spain.
abstract: BACKGROUND
  Lung cancer is the third most frequent neoplastic tumour in Spain, with around 27 000 new cases diagnosed per year; 80-95% of these are non-small-cell cancer (NSCLC), and the majority of cases are diagnosed in advanced stages of the disease, and for this reason it is one of the oncologic conditions with higher mortality rates (21.4% mean survival at 5 years). The main treatment regimens used for first-line treatment of NSCLC are: cisplatin/pemetrexed (cis/pem), cisplatin/gemcitabine/ bevacizumab (cis/gem/bev), and carboplatin/paclitaxel/ bevacizumab (carb/pac/bev). The objective of this study was to evaluate the cost-effectiveness ratio of antineoplastic 1st line NSCLC treatment regimens, from the point of view of hospital management.
  
  
  METHODS
  A cost-efficacy mathematical model was prepared, based on a decision tree. The efficacy variable was Progression Free Survival, obtained from the PARAMOUNT, AVAIL and SAIL Phase III clinical trials. The study was conducted from the perspective of the hospital management, considering only the direct costs of drug acquisition. A deterministic sensitivity analysis was conducted to confirm the robustness of outcomes.
  
  
  RESULTS
  The PFS obtained in clinical trials with cis/pem, cis/ gem/bev and carb/pac/bev was: 6.9, 6.7 and 6.2 months, respectively. Based on our model, the mean cost of treatment per patient for these regimens was: 19 942 €, 15 594 € and 36 095 €, respectively. The incremental cost-effectiveness ratio per month of additional PFS between cis/pem and cis/gem/bev was 19 303 €. Estimating a 30% reduction in acquisition costs for pemetrexed (Alimta®Eli Lilly Nederland B.V.), due to the forthcoming launch of generic medications, the cis/pem treatment would become the predominant alternative for 1st line treatment of NSCLC patients, by offering the best health results at a lower cost.
authors.affiliation: Pharmacy Unit, Complejo Hospitalario Universitario de Canarias.. jonathangnz@hotmail.com.
authors.forename: Jonathan
authors.initials: J
authors.lastname: González García
authors.affiliation: Pharmacy Unit, Complejo Hospitalario Universitario de Canarias.. fgunico@gmail.com.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gutiérrez Nicolás
authors.affiliation: Pharmacy Unit, Complejo Hospitalario Universitario de Canarias.. fgunico@gmail.com.
authors.forename: Gloria Julia
authors.initials: GJ
authors.lastname: Nazco Casariego
authors.affiliation: Evaluation Department, Canarian Health Service.. fgunico@gmail.com.
authors.forename: Cristina
authors.initials: C
authors.lastname: Valcárcel Nazco
authors.affiliation: Oncology Unit, Complejo Hospitalario Universitario de Canarias. Spain.. fgunico@gmail.com.
authors.forename: Jose Norberto
authors.initials: JN
authors.lastname: Batista López
authors.affiliation: Oncology Unit, Complejo Hospitalario Universitario de Canarias. Spain.. fgunico@gmail.com.
authors.forename: Juana
authors.initials: J
authors.lastname: Oramas Rodríguez
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000191:economics*; D002945:Cisplatin / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D017721:Hospital Costs; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics*; D008962:Models, Theoretical; D000068437:Pemetrexed / Q000008:administration & dosage* / Q000191:economics*; D019057:Quality-Adjusted Life Years; D013030:Spain
chemical_list: D000970:Antineoplastic Agents; D000068437:Pemetrexed; D002945:Cisplatin