A Cost-Effectiveness Analysis of Docetaxel in the Second-Line Treatment of Non-Small Cell Lung Cancer

Holmes, Jeremy; Dunlop, David J.; Hemmett, Lindsay; Sharplin, P; Bose, Uday

doi:10.2165/00019053-200422090-00003

Cited by 44 publications

(42 citation statements)

References 6 publications

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“…Few economic studies of second-line treatments for advanced NSCLC have been published [21,27,28], and most are based on models using clinical trial data. The ICER of second-line erlotinib versus placebo in patients with previously treated advancedstage NSCLC has recently been published [29].…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of three strategies for second-line erlotinib initiation in nonsmall-cell lung cancer: the ERMETIC study part 3

Borget¹,

Cadranel²,

Pignon³

et al. 2011

Eur Respir J

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Several clinical and biological parameters are known to influence the efficacy of second-line erlotinib therapy for nonsmall cell lung cancer (NSCLC), but their medico-economic impact has not been evaluated. The objective of this study was to compare the incremental costeffectiveness ratios of strategies for second-line erlotinib initiation in NSCLC: clinically guided initiation (nonsmoking females with adenocarcinoma received erlotinib; all other patients received docetaxel) and biologically guided selection (patients with epidermal growth factor receptor (EGFR) mutation received erlotinib; patients with wild-type EGFR or unknown status received docetaxel), compared with initiation with no patient selection (strategy reference).A Markov model was constructed. Outcomes (overall and progression-free survival), transition probabilities and direct medical costs (from the French third-party payer's perspective) were prospectively collected for individual patients treated with either erlotinib or docetaxel, from treatment initiation to disease progression. Published data were used to estimate utilities and post-progression costs. Sensitivity analyses were performed.The biologically and clinically guided strategies were both more efficient (incremental qualityadjusted life-yrs equal to 0.080 and 0.081, respectively) and less expensive (cost decrease equal to J5,020 and J5,815, respectively) than the no-selection strategy, and the biologically guided strategy was slightly less expensive than the clinically guided strategy. Sensitivity analyses confirmed the robustness of the results.The cost-effectiveness of second-line NSCLC treatment is improved when patients are selected on either clinical or biological grounds.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of three strategies for second-line erlotinib initiation in nonsmall-cell lung cancer: the ERMETIC study part 3

Borget¹,

Cadranel²,

Pignon³

et al. 2011

Eur Respir J

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“…These papers were published between 2002 and 2013; seven papers 63,65,66,[68][69][70][71] were published from 2010 onwards. All of the papers described full EEs using cost minimisation analysis (n = 1 64 ), cost-effectiveness analysis (n = 6 65,67,69,70,72 ) and/or cost-utility analysis (n = 6 [63][64][65]68,71,73 ) techniques. All but one study 70 used cost per QALY gained or cost per LY gained as the measure of cost-effectiveness.…”

Section: Cost-effectiveness Review: Resultsmentioning

confidence: 99%

“…All but one study 70 used cost per QALY gained or cost per LY gained as the measure of cost-effectiveness. The results of six studies 64,65,67,68,71,73 were derived from use of an economic model: one study 63 conducted an economic analysis alongside a RCT and the remaining four studies 66,69,70,72 conducted retrospective reviews of costs and/or benefits. Four studies 66,69,70,72 were carried out from a Canadian NHS perspective, two 67,71 from that of the UK NHS perspective, one 73 from the US perspective, three [63][64][65] from a European perspective and one 68 from a Thai payer perspective.…”

Section: Cost-effectiveness Review: Resultsmentioning

confidence: 99%

“…). Other comparisons were erlotinib versus BSC (n = 3 64,66,70 ), pemetrexed versus docetaxel (n = 4 63,65,68,73 ), docetaxel versus BSC (n = 3 63,67,72 ), erlotinib versus pemetrexed (n = 2 64,73 ), pemetrexed versus BSC (n = 1 63 ) and gefitinib versus docetaxel (n = 1 68 ). The populations described in the EEs appeared to have similar patient characteristics, namely previously treated stage III-IV patients with advanced NSCLC.…”

Section: Cost-effectiveness Review: Resultsmentioning

confidence: 99%

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Erlotinib and gefitinib for treating non-small cell lung cancer that has progressed following prior chemotherapy (review of NICE technology appraisals 162 and 175): a systematic review and economic evaluation

Greenhalgh

Bagust

Boland

et al. 2015

Health Technol Assess

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BackgroundLung cancer is the second most diagnosed cancer in the UK. Over 70% of lung cancers are non-small cell lung cancers (NSCLCs). Patients with stage III or IV NSCLC may be offered treatment to improve survival, disease control and quality of life. One-third of these patients receive further treatment following disease progression; these treatments are the focus of this systematic review.ObjectivesTo appraise the clinical effectiveness and cost-effectiveness of erlotinib [Tarceva®, Roche (UK) Ltd] and gefitinib (IRESSA®, AstraZeneca) compared with each other, docetaxel or best supportive care (BSC) for the treatment of NSCLC after disease progression following prior chemotherapy. The effectiveness of treatment with gefitinib was considered only for patients with epidermal growth factor mutation-positive (EGFR M+) disease.Data sourcesFour electronic databases (EMBASE, MEDLINE, The Cochrane Library, PubMed) were searched for randomised controlled trials (RCTs) and economic evaluations. Manufacturers’ evidence submissions to the National Institute for Health and Care Excellence were also considered.Review methodsOutcomes for three distinct patient groups based on EGFR mutation status [EGFR M+, epidermal growth factor mutation negative (EGFR M–) and epidermal growth factor mutation status unknown (EGFR unknown)] were considered. Heterogeneity of the data precluded statistical analysis. A de novo economic model was developed to compare treatments (incremental cost per quality-adjusted life-year gained).ResultsTwelve trials were included in the review. The use of gefitinib was compared with chemotherapy (n = 6) or BSC (n = 1), and the use of erlotinib was compared with chemotherapy (n = 3) or BSC (n = 1). One trial compared the use of gefitinib with the use of erlotinib. No trials included solely EGFR M+ patients; all data were derived from retrospective subgroup analyses from six RCTs [Kim ST, Uhm JE, Lee J, Sun JM, Sohn I, Kim SW,et al.Randomized phase II study of gefitinib versus erlotinib in patients with advanced non-small cell lung cancer who failed previous chemotherapy.Lung Cancer2012;75:82–8, V-15-32, Tarceva In Treatment of Advanced NSCLC (TITAN), BR.21, IRESSA Survival Evaluation in Lung cancer (ISEL) and IRESSA NSCLC Trial Evaluating REsponse and Survival versus Taxotere (INTEREST)]. These limited data precluded conclusions regarding the clinical effectiveness of any treatment for EGFR M+ patients. For EGFR M– patients, data were derived from the TArceva Italian Lung Optimization tRial (TAILOR) trial and Docetaxel and Erlotinib Lung Cancer Trial (DELTA). Retrospective data were also derived from subgroup analyses of BR.21, Kimet al., TITAN, INTEREST and ISEL. The only statistically significant reported results were for progression-free survival (PFS) for TAILOR and DELTA, and favoured docetaxel over erlotinib [TAILOR hazard ratio (HR) 1.39, 95% confidence interval (CI) 1.06 to 1.82; DELTA HR 1.44, 95% CI 1.08 to 1.92]. In EGFR unknown patients, nine trials (INTEREST, IRESSA as Second-line Therapy in Advanced NSCLC – KoreA, Li, Second-line Indication of Gefitinib in NSCLC, V-15-32, ISEL, DELTA, TITAN and BR.21) reported overall survival data and only one (BR.21) reported a statistically significant result favouring the use of erlotinib over BSC (HR 0.7, 95% CI 0.58 to 0.85). For PFS, BR.21 favoured the use of erlotinib when compared with BSC (HR 0.61, 95% CI 0.51 to 0.74) and the use of gefitinib was favoured when compared with BSC (HR 0.82, 95% CI 0.73 to 0.92) in ISEL. Limitations in the clinical data precluded assessment of cost-effectiveness of treatments for an EGFR M+ population by the Assessment Group (AG). The AG’s economic model suggested that for the EGFR M– population, the use of erlotinib was not cost-effective compared with the use of docetaxel and compared with BSC. For EGFR unknown patients, the use of erlotinib was not cost-effective when compared with BSC.Conclusions/future workThe lack of clinical data available for distinct patient populations limited the conclusions of the assessment. Future trials should distinguish between patients with EGFR M+ and EGFR M– disease.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…30 The base case cost-effectiveness analysis reported a cost per life-year gained of 13,863 pounds sterling for docetaxel 75 mg/m 2 . Sensitivity analysis showed that the number of treatment cycles per patient, which affects total treatment cost, had the most influence on cost per life-year gained in the base case scenario.…”

Section: Discussionmentioning

confidence: 99%

Economic evaluation of pemetrexed versus erlotinib as second-line treatment of patients with advanced/metastatic non-small cell lung cancer in Greece: a cost minimization analysis

Fragoulakis¹,

Pallis²,

Καϊτελίδου³

et al. 2012

LCTT

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Objectives: An economic evaluation was conducted in conjunction with a prospective, multicenter, randomized trial, to compare pemetrexed with erlotinib in pretreated patients with metastatic non-small cell lung cancer (NSCLC) in Greece. Methods: The effectiveness of treatments examined was comparable; thus, cost minimization analysis was conducted to evaluate which option is less costly. Patient-level resource utilization data were combined with unit cost data, which were aggregated to compute the total treatment cost for each patient. The analysis was conducted with respect to the individual incurring the cost. Due to the limited life-expectancy of the patients, discounting was unnecessary. Since data were right censored, the Bang and Tsiatis method was employed to identify unbiased estimators of the mean cost per treatment arm, while other methods were employed for sensitivity analysis. To analyze uncertainty and to construct uncertainty intervals (UI), stochastic analysis was performed based on 5000 bootstrap replications. Results:The one-year survival rate was 28.3% in the pemetrexed arm and 31.7% in the erlotinib arm, while the corresponding median survival over the follow-up period was 7.1 and 6.7 months, respectively (P = 0.765). Total cost in the pemetrexed arm was €10508 (95% UI: €9552-€11488), while in the erlotinib arm the cost was €9563 (95% UI: €8499-€10711); thus, no statistically significant difference was found between the comparators (P = 0.206). Results remained constant for all sensitivity analyses. Conclusions: There is no survival or cost difference between erlotinib and pemetrexed; thus, these therapies are equivalent. Further studies are needed to determine whether other parameters, such as quality of life, differ among treatment options.

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A Cost-Effectiveness Analysis of Docetaxel in the Second-Line Treatment of Non-Small Cell Lung Cancer

Abstract: This model suggests, with its underlying assumptions and data, docetaxel 75 mg/m(2) in 3-weekly cycles is a cost-effective second-line treatment, from the perspective of the NHS, for pretreated NSCLC in terms of survival gains made for a reasonable increase in costs.

Cited by 44 publications

References 6 publications

Cost-effectiveness of three strategies for second-line erlotinib initiation in nonsmall-cell lung cancer: the ERMETIC study part 3

Cost-effectiveness of three strategies for second-line erlotinib initiation in nonsmall-cell lung cancer: the ERMETIC study part 3

Erlotinib and gefitinib for treating non-small cell lung cancer that has progressed following prior chemotherapy (review of NICE technology appraisals 162 and 175): a systematic review and economic evaluation

Economic evaluation of pemetrexed versus erlotinib as second-line treatment of patients with advanced/metastatic non-small cell lung cancer in Greece: a cost minimization analysis

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