title: The cost-effectiveness of a NSCLC patient assistance program for pemetrexed maintenance therapy in People's Republic of China.
abstract: BACKGROUND
  Eli Lilly and the China Primary Health Care Foundation are currently implementing a patient assistance program (PAP) in China, which allows first-line nonsquamous non-small-cell lung cancer (NSCLC) patients who complete four cycles of pemetrexed induction therapy to receive free, continuous pemetrexed maintenance therapy.
  
  
  OBJECTIVE
  To estimate the cost-effectiveness of pemetrexed maintenance therapy vs basic standard care (BSC) and the economic impacts of providing a PAP for pemetrexed maintenance therapy to NSCLC patients who have completed pemetrexed induction therapy in a Chinese health care setting.
  
  
  METHODS
  We developed a novel decision-analytic model to evaluate the long-term costs and clinical efficacy of pemetrexed plus BSC vs BSC alone. We utilized a three-state (progression-free survival, progressed disease, and dead) partition survival model for both the clinical and economic aspects of the analysis. Cost and health utility estimates were derived from the literature. We performed a scenario analysis to estimate the real-world impact of introducing the PAP in China by comparing the use of the PAP vs non-PAP. Model uncertainty was evaluated using one-way and multivariate probabilistic sensitivity analysis.
  
  
  RESULTS
  Compared to BSC, pemetrexed plus BSC resulted in a gain of 0.22 years of life (95% credible range [CR]: 0.04-0.46) and 0.13 quality-adjusted life years (95% CR: 0.04-0.26) per patient, at an increased cost of $28,105 (95% CR: -$22,720 to $48,646) without a PAP and $3,068 (95% CR: -$1,263 to $9,163) with a PAP. The incremental cost-effectiveness ratio for pemetrexed plus BSC vs BSC alone was cost-prohibitive at $222,700 for non-PAP, but cost-effective at $24,319 with a PAP.
  
  
  CONCLUSIONS
  Our study suggests that maintenance pemetrexed therapy following pemetrexed induction for patients with advanced NSCLC is likely to be highly non-cost-effective in the absence of a PAP, but the pending implementation of the PAP promises to make it cost-effective, with a >90% probability of cost-effectiveness at a Chinese willingness-to-pay threshold per quality-adjusted life year.
authors.affiliation: Lilly Suzhou Pharmaceutical Company, Ltd., Shanghai, People's Republic of China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Shi
authors.affiliation: Shanghai Health Development Research Center, Shanghai, People's Republic of China.
authors.forename: Shanlian
authors.initials: S
authors.lastname: Hu
authors.affiliation: Elysia Group, Ltd., Taipei, Taiwan, Republic of China.
authors.forename: Wesley E
authors.initials: WE
authors.lastname: Furnback
authors.affiliation: Elysia Group, Ltd., Taipei, Taiwan, Republic of China.
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Guzauskas
authors.affiliation: Lilly Suzhou Pharmaceutical Company, Ltd., Shanghai, People's Republic of China.
authors.forename: Jiejing
authors.initials: J
authors.lastname: Shen
authors.affiliation: Elysia Group, Ltd., Taipei, Taiwan, Republic of China.
authors.forename: Bruce Cm
authors.initials: BC
authors.lastname: Wang
keywords: basic standard care; cost-utility analysis; non-small-cell lung cancer; patient assistance program; pemetrexed