Cost-Effectiveness Comparison of First-Line Therapies for Advanced Non–Small-Cell Lung Cancer

November 2012, Vol 3, No 8

Vienna, Austria—Costs associated with first-line pemetrexed/cisplatin are significantly lower than those of carboplatin/paclitaxel/bevacizumab for the treatment of advanced non–small-cell lung cancer (NSCLC), according to an analysis presented at the 2012 European Society for Medical Oncology Congress.

“This is the first known study that used real-world, nontrial data to evaluate the outpatient care cost-effectiveness of pemetrexed/cisplatin relative to 2 other first-line regimens for patients with advanced nonsquamous NSCLC,” said Katherine B. Winfree, PhD, MPH, Research Scientist, Global Outcomes, Oncology, Eli Lilly and Company.

The study compared the incremental cost-effectiveness of outpatient management with these regimens in patients with advanced NSCLC. The data came from the International Oncology Network database, which documents care by 20 large US community oncology practices. The index date was the initiation of first-line therapy.

Of approximately 5000 patients, 234 (78 matched pairs per treatment type) were selected for the cost-effectiveness analysis. Costs included charges for chemotherapy, supportive care, and physician and nursing services.

Pemetrexed/Cisplatin Less Costly, More Effective than Triplet

Incremental costs were measured as differences in costs during the progression-free survival (PFS) and overall survival (OS) periods for each matched pair.

Median PFS was 128 days in patients receiving pemetrexed/cisplatin versus 112 for patients receiving carboplatin/ paclitaxel/bevacizumab (P = .007) and 105 days in patients receiving carboplatin/paclitaxel (P = .004).

The median OS was 327 days in patients treated with pemetrexed/cisplatin, 279 days in patients treated with carboplatin/paclitaxel/bevacizumab, and 234 in patients treated with carboplatin/paclitaxel, a nonsignificant difference.

Considering the treatment costs, as well as the improvement in PFS, the costs associated with first-line therapy were significantly lower with pemetrexed/cisplatin than with carboplatin/ paclitaxel/bevacizumab; however, as expected, the costs were significantly higher with pemetrexed/cisplatin treatment than with carboplatin/paclitaxel—primarily a result of the underlying difference in the drug costs, Dr Winfree noted.

Mean PFS costs were approximately $43,000 for pemetrexed/cisplatin, $61,000 for carboplatin/paclitaxel/ bevacizumab, and $18,000 for carboplatin/paclitaxel. The overall costs of treatment were approximately $40,000, $58,000, and $14,000, respectively.

“Costs associated with first-line therapy with pemetrexed/cisplatin were significantly lower than those of carboplatin/paclitaxel/bevacizumab. Further evaluation is warranted to identify possible drivers of this difference, such as bevacizumab utilization (including maintenance), differences in number of cycles, and so forth,” Dr Winfree said.

“But patients treated with pemetrexed/cisplatin experienced a significant PFS benefit and trended toward being more effective and less costly compared with carboplatin/paclitaxel/bevacizumab for both PFS and OS,” she said.

More Costly, but Improved PFS, versus Carboplatin/Paclitaxel

The analysis also showed that pemetrexed/cisplatin was more costly than carboplatin/paclitaxel, but with a potential incremental clinical benefit, Dr Winfree emphasized. Patients treated with pemetrexed/cisplatin had a significant PFS benefit compared with carboplatin/paclitaxel/bevacizumab. The doublet was more effective and less costly than carboplatin/paclitaxel/ bevacizumab for PFS and OS (although the differences were not significant).

“Therefore, depending on society’s or payers’ willingness to pay threshold, pemetrexed/cisplatin may be seen as cost-effective compared to carboplatin/paclitaxel, because it demonstrated greater effectiveness at a higher cost,” Dr Winfree concluded.

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