Decision Framework for Chemotherapeutic Interventions for Metastatic Non-Small-Cell Lung Cancer

Berthelot, Jean‐Marie; Will, B P; Evans, William K.; Coyle, Doug; Earle, Craig C.; Bordeleau, Louise

doi:10.1093/jnci/92.16.1321

Cited by 63 publications

(24 citation statements)

References 25 publications

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“…This CUA of chemotherapy for metastatic NSCLC applied a decision-analysis model on a hypothetical cohort of lung cancer patients. The analysis used mean utility estimates provided by a survey amongst oncologists [3]. No other CUA alongside cancer clinical trials has as yet been reported on chemotherapy for advanced-stage NSCLC, which is probably related to the fact that the reported differences in QoL between platinum doublets only show discrete differences at best [11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

“…In the last step, these utilities were combined with the survival data from the randomised study in order to obtain QALYs. For the baseline calculation, the average utilities were multiplied by the LYS, an approach also used by BERTHELOT et al [3] For the sensitivity analyses, the QALYs were calculated from the area under the utility curve for the 24-week treatment period by making a summation of the utility per week.…”

Section: Survival and Cost-effectivenessmentioning

confidence: 99%

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

Dooms

Lievens²,

Vansteenkiste³

2006

Eur Respir J

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Survival and Cost-effectivenessmentioning

confidence: 99%

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

Dooms

Lievens²,

Vansteenkiste³

2006

Eur Respir J

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“…A cost-benefit analysis supports the use of chemotherapy regimens and the abandonment of best supportive care as the standard of care for patients with advanced NSCLC [61].…”

Section: Comparison Of New Protocolsmentioning

confidence: 97%

New Drugs in the Palliative Chemotherapy of Advanced Non-Small-Cell Lung Cancer

Malayeri¹,

Pirker²,

Huber³

2001

Oncol Res Treat

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In inoperable advanced non-small-cell lung cancer (NSCLC), palliative chemotherapy is established and aims at palliation of symptoms, improvement of quality of life and prolongation of survival. In the last years, several new drugs with enhanced activity towards NSCLC and improved toxicity profile have been characterised, for example vinorelbine, gemcitabine, paclitaxel and docetaxel. Data from randomised trials suggest that regimens containing new drugs are more active than older combinations. Platin-based combinations of either vinorelbine, gemcitabine or paclitaxel have resulted in better outcome than cisplatin alone and new drugs in combination with platins are more active than the corresponding single agent. Non-platin-based combinations must be considered investigational until their non-inferiority to platin-based protocols has been proven in randomised trials on large patient populations. Patients with good performance status and adequate organ function should receive platin-based chemotherapy that includes the new drugs (vinorelbine, gemcitabine, paclitaxel or docetaxel). New drugs without platins are suitable for elderly patients and patients with poor performance status. Second-line chemotherapy prolongs survival in selected patients and should be particularly offered to patients with good performance status.

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“…In fact there have been no empirical studies that have tried to elicit utilities directly for NSCLC patients undergoing PET tests. Those employed by the HTBS model were taken from earlier reports by Berthelot et al [9] and Marshall et al [10] using estimates made by oncologists rather than from patients themselves.…”

Section: Objectivesmentioning

confidence: 99%

The value of positron emission tomography in patients with non-small cell lung cancer

Kee

Erridge

Bradbury

et al. 2010

European Journal of Radiology

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a b s t r a c tBackground: Pre-operative assessment of non-small cell lung cancer (NSCLC) is a major application of positron emission tomography (FDG-PET). Despite substantial evidence of diagnostic accuracy, relatively little attention has been paid to its effects on patient outcomes. This paper addresses this by extending an existing decision model to include patient-elicited utilities. Patients and methods:A decision-tree model of the effect of FDG-PET on pre-operative staging was converted to a Markov model. Utilities for futile and appropriate thoracotomy were elicited from 75 patients undergoing staging investigation for NSCLC. The decision model was then used to estimate the expected value of perfect information (EVPI) associated with three sources of uncertainty-the accuracy of PET, the accuracy of CT and the patient related utility of a futile thoracotomy. Results: The model confirmed the apparent cost-effectiveness of FDG-PET and indicated that the EVPI associated with the utility of futile thoracotomy considerably exceeds that associated with measures of accuracy. Conclusion:The study highlights the importance of patient related utilities in assessing the costeffectiveness of diagnostic technologies. In the specific case of PET for pre-operative staging of NSCLC, future research effort should focus on such elicitation, rather than further refinement of accuracy estimates.

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Decision Framework for Chemotherapeutic Interventions for Metastatic Non-Small-Cell Lung Cancer

Cited by 63 publications

References 25 publications

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

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

New Drugs in the Palliative Chemotherapy of Advanced Non-Small-Cell Lung Cancer

The value of positron emission tomography in patients with non-small cell lung cancer

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