Cost-Effectiveness of Continuation Maintenance Pemetrexed After Cisplatin and Pemetrexed Chemotherapy for Advanced Nonsquamous Non–Small-Cell Lung Cancer: Estimates From the Perspective of the Chinese Health Care System

• Published in: Clinical therapeutics 2013, Vol.35 (1), p.54-65
• Main Authors: Zeng, Xiaohui, PhD, Peng, Liubao, BS, Li, Jianhe, MS, Chen, Gannong, MS, Tan, Chongqing, PhD, Wang, Siying, MS, Wan, Xiaomin, PhD, Ouyang, Lihui, MS, Zhao, Ziying, MS
• Format: Article
• Language: English
• Subjects: Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - economics; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; cancer; Cancer therapies; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - economics; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Chemotherapy; China; Cisplatin - administration & dosage; Cisplatin - economics; Clinical Trials, Phase III as Topic; continuation maintenance treatment; Cost-Benefit Analysis; cost-effectiveness; Delivery of Health Care - economics; Disease-Free Survival; Drug Administration Schedule; Drug Costs; Epidermal growth factor; Estimates; Glutamates - administration & dosage; Glutamates - economics; Guanine - administration & dosage; Guanine - analogs & derivatives; Guanine - economics; Health care expenditures; Histology; Humans; Internal Medicine; lung; Lung cancer; Lung Neoplasms - drug therapy; Lung Neoplasms - economics; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Markov Chains; Medical Education; Medical sciences; Models, Economic; Pemetrexed; Pharmacology. Drug treatments; Pneumology; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; Sensitivity analysis; Studies; Time Factors; Treatment Outcome; Tumors of the respiratory system and mediastinum
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2012.12.013

Abstract Background Continuation maintenance treatment with pemetrexed is approved by current clinical guidelines as a category 2A recommendation after induction therapy with cisplatin and pemetrexed chemotherapy (CP strategy) for patients with advanced nonsquamous non–small-cell lung cancer (NSCLC). However, the cost-effectiveness of the treatment remains unclear. Objective We completed a trial-based assessment, from the perspective of the Chinese health care system, of the cost-effectiveness of maintenance pemetrexed treatment after a CP strategy for patients with advanced nonsquamous NSCLC. Methods A Markov model was developed to estimate costs and benefits. It was based on a clinical trial that compared continuation maintenance pemetrexed therapy plus best supportive care (BSC) versus placebo plus BSC after a CP strategy for advanced nonsquamous NSCLC. Sensitivity analyses were conducted to assess the stability of the model. Results The model base case analysis suggested that continuation maintenance pemetrexed therapy after a CP strategy would increase benefits in a 1-, 2-, 5-, or 10-year time horizon, with incremental costs of $183,589.06, $126,353.16, $124,766.68, and $124,793.12 per quality-adjusted life-year gained, respectively. The most sensitive influential variable in the cost-effectiveness analysis was the utility of the progression-free survival state, followed by proportion of patients with postdiscontinuation therapy in both arms, proportion of BSC costs for PFS versus progressed survival state, and cost of pemetrexed. Probabilistic sensitivity analysis indicated that the cost-effective probability of adding continuation maintenance pemetrexed therapy to BSC was zero. One-way and probabilistic sensitivity analyses revealed that the Markov model was robust. Conclusions Continuation maintenance of pemetrexed after a CP strategy for patients with advanced nonsquamous NSCLC is not cost-effective based on a recent clinical trial. Decreasing the price or adjusting the dosage of pemetrexed may be a better option for meeting the treatment demands of Chinese patients ClinicalTrials.gov identifier: NCT00789373.