Cost–utility analysis of chemotherapy in symptomatic advanced nonsmall cell lung cancer

Abstract

When using chemotherapy in patients with a short life expectancy, outcomes such as symptom improvement or clinical benefit receive increasing attention. Outcomes of subjective benefit to the patient can be rated as a utility in order to perform health economic analyses and comparisons with other treatment conditions. A cost-utility analysis has been performed alongside a prospective randomised clinical trial comparing single agent gemcitabine to cisplatin-based chemotherapy in symptomatic advanced nonsmall cell lung cancer patients.Global quality of life as well as resource utilisation data were collected during first-line chemotherapy for both treatment arms. Incremental costs, utilities and cost-utility ratio were calculated.Per patient, an incremental cost of J1,522 was obtained for gemcitabine compared to cisplatinvindesine, mainly as a consequence of the direct cost of the cytotoxic drugs. When combined with utilities, this resulted in an incremental cost-utility ratio for gemcitabine of J13,836 per qualityadjusted life year gained.In conclusion, although the least expensive strategy is cisplatin-vindesine, the greater clinical benefit of gemcitabine, resulting in an acceptable incremental cost-utility ratio as compared with other healthcare interventions, balances its higher cost. The gains in subjective outcome achieved with palliative chemotherapy are critical from both a clinical and a health economic point of view.

Economic Evaluation of PET and PET/CT in Oncology: Evidence and Methodologic Approaches

“…Although CEA allows a comparison of the costs and effectiveness of alternatives (e.g., costs per life-year saved), CUA is superior in that health-related quality-of-life (HRQL) measures combine differences in life-years saved with differences in toxicity profiles and adverse events (46,47). A CUA is even more important when differences in clinically relevant outcomes between interventions are expected to be small.…”

Differences in Practice Patterns and Costs between Small Cell and Non-Small Cell Lung Cancer Patients in Japan

“…Clinically relevant characteristics (e.g., age, comorbidities, cancer stage, and pathological diagnosis) often influence costs. Due to the growing financial burden of LC, many economic evaluations of new evolving pharmaceuticals, diagnostic and therapeutic technologies have been conducted (Dooms et al 2006;Pimentel et al 2006;Ng et al 2007;Spiro et al 2008).…”

“…Of the estimated 123,000 cases of LC in Japan in 2006, 70% were 65 years or older, and healthcare expenditures for LC were $US2.63 billion (Ministry of Health, Welfare and Labor, 2006). LC has been attracting attention both clinically and economically, as new chemotherapeutic agents and diagnostic imaging techniques continue to be developed (Dooms et al 2006;Pimentel et al 2006;Maniadakis et al 2007;Ng et al 2007;Spiro et al 2008). These advances in medical care have benefited LC patients (Oliver et al 2001;Conron et al 2007;Ostgathe et al 2008).…”

“…Although many LC studies have noted a difference in practice between patients with SCLC and those with NSCLC (Oliver et al 2001;Dooms et al 2006;Pimentel et al 2006;Maniadakis et al 2007;Ng et al 2007;Ostgathe et al 2008), the study population were often limited to either small cell LC (SCLC) patients or non-small cell LC (NSCLC) patients. For effective management of health policy for the entire LC population, it is necessary to understand the effect of LC-related variables and prioritize these variables.…”

Chemotherapy for glioblastoma

“…Internationally accepted upper benchmarks for the cost per qualityadjusted life year are in the range from 40,000 to 45,000 Euros. 13 The incremental cost of TMZ per qualityadjusted life year may be above this upper limit. 12,14 The enormous costs of TMZ with hitherto undiscernable advantages compared with ACNU plus VM26 suggest the need to start a direct comparison of the 2 regimens in a new prospective, randomized, phase 3 trial in patients with GB.…”