A Cost-Effectiveness Analysis of Docetaxel versus Pemetrexed in Second-Line Chemotherapy for Stage IIIb or IV Non-Small Cell Lung Cancer in China

Abstract

Background: To study the cost-efficacy of docetaxel and pemetrexed as single agents versus platinum-based combination agents in second-line treatment of stage IIIb or IV non-small cell lung cancer (NSCLC) patients by evaluating chemotherapeutic indexes and medical costs. Methods: Treatment responses were evaluated by progression-free survival (PFS), overall survival (OS), hematological and gastrointestinal toxicities. Results: Two hundred and seven stage IIIb or IV NSCLC patients were recruited to this clinical observation retrospective study. Thirty-four subjects were treated with docetaxel (group A), 98 with platinum-based doublet chemotherapy with docetaxel (group B), 42 with pemetrexed (group C), and 33 patients with platinum-based doublet combination therapy with pemetrexed (group D). The average PFS of groups A and B was 3.28 and 4.58 months, respectively (p = 0.042). The mean PFS of groups C and D was 3.1 and 4.98 months, respectively (p = 0.017). The mean OS of these groups was 12.88, 13.17, 12.40 and 13.04 months, respectively, without significant differences. The total medical costs in these four groups amounted to USD 5,533, 7,745, 8,569 and 15,291, respectively. Conclusions: Platinum-based doublet chemotherapy with docetaxel or pemetrexed could significantly increase PFS, however, without significant OS improvement in comparison with using them as single agents. The medical expenses associated with doublet therapy were much higher than those associated with single therapy with a significant portion of the medical expenses spent on treating hematological and gastrointestinal toxicity.

The Qualification of Docetaxel or Erlotinib for Second-Line Therapy Should Be Based on Clinical and Molecular Predictive Factors

“…In the present study, the effectiveness of docetaxel was partially lower than in studies on second-line treatment reported by Fossela et al [4], Shepherd et al [3], Hanna et al [7 ]and others [33,34]: RR was similar and ranged from 6.7% in the study by Fossela et al [4] to 8.8% in the study by Hanna et al [7]. The SD rate was lower in our study (26.4%) than in the above-mentioned phase III studies (36-46%).…”

“…Median response durations were 9.1 months in the study by Fossela et al [4], 6.4 months in the study by Shepherd et al [3], 5.2 months in the study by Hanna et al [7] and 4.75 months in our study. However, patients with several adverse factors were excluded from phase III studies [3,4,7,33,34]. These patients could be qualified for docetaxel therapy according to the pharmacokinetics and safety characteristics of docetaxel in our study.…”

Pemetrexed for Previously Treated Patients with Non-Small Cell Lung Cancer and Differences in Efficacy according to Thymidylate Synthase Expression

“…PFS and response rate in our patients are similar to those of previous reports [5,19,20,21,22,23]. Moreover, owing to the adequate supportive care, the transition rate to another chemotherapy regimen after pemetrexed monotherapy was favorable (65.2%), and the continuity of chemotherapy was maintained in comparison with a previous report [5].…”

Nivolumab Versus Docetaxel in a Predominantly Chinese Patient Population With Previously Treated Advanced NSCLC: CheckMate 078 Randomized Phase III Clinical Trial

“…In the docetaxel treatment group, exponential distribution with a median OS of 10 months for squamous NSCLC and 12 months for nonsquamous NSCLC was assumed, as per historical data in Asian patients. [10][11][12][13][14][15] For the patients with squamous NSCLC in the nivolumab treatment group, exponential distribution with a 16.7-month median OS was assumed providing a hazard ratio (HR) of 0.6. Treatment effect assumption was based on the efficacy results in CheckMate 017 (HR for OS: 0.59; 95% confidence interval [CI]: 0.44-0.79).…”