Abstract
In past decades, studies focusing on new chemotherapeutic agents for patients with inoperable non-small-cell lung cancer have reported only modest gains in survival. These health gains are achieved at considerable cost, but economic evidence is lacking on superiority of one agent in terms of cost effectiveness. The objective of this systematic review was to assess fully published cost-effectiveness studies comparing the new agents docetaxel, paclitaxel, vinorelbine, gemcitabine and pemetrexed, and the targeted therapies erlotinib and gefitinib with one another.
We performed systematic searches in the bibliographic databases PubMed, EMBASE and Health Economic Evaluations (HEED) [via the Cochrane Library] for fully published studies from the past 10 years. Studies were screened by two independent reviewers according to a priori inclusion criteria. The methodological quality of the included studies was evaluated by two independent reviewers using standardized assessment tools.
A total of 222 potential studies were identified; 11 studies and six reviews were included. The methodological quality of the full economic evaluations was fairly good. Transparency in costs and resource use, details on statistical tests and sensitivity analysis were points for improvement. In first-line treatment, gemcitabine+cisplatin was cost effective compared with other platinum-based regimens (paclitaxel, docetaxel and vinorelbine). In one study, pemetrexed+ cisplatin was cost effective compared with gemcitabine+cisplatin in patients with non-squamous-cell carcinoma. In second-line treatment, docetaxel was cost effective compared with best supportive care; erlotinib was cost effective compared with placebo; and docetaxel and pemetrexed were dominated by erlotinib.
We found indications of superiority in terms of cost effectiveness for gemcitabine+cisplatin in a first-line setting, and for erlotinib in a second-line setting.
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References
Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin 2008 Mar; 58 (2): 71–96
National Institute for Health and Clinical Excellence. Lung cancer: the diagnosis and treatment of lung cancer. London: NICE, 2011 Apr
Integraal Kankercentrum Nederland. Non-small-cell lung cancer: Dutch guidelines [in Dutch]. Utrecht: IKNL, 2011 [online]. Available from URL: http://www.oncoline.nl/richtlijn/item/index.php?pagina=/richtlijn/item/pagina.php&richtlijn_id=799 [Accessed 2011 May 22]
Goffin J, Lacchetti C, Ellis PM, et al. First-line systemic chemotherapy in the treatment of advanced non-small cell lung cancer: a systematic review. J Thorac Oncol 2010 Feb; 5 (2): 260–74
Pompen M, Gok M, Novak A, et al. Direct costs associated with the disease management of patients with unresectable advanced non-small-cell lung cancer in the Netherlands. Lung Cancer 2009; 64 (1): 110–6
Drummond MF, Jefferson TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ Economic Evaluation Working Party. BMJ 1996; 313: 275–83
Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. Cochrane Collaboration, 2011 Mar [online]. Available from URL: http://www.cochrane-handbook.org [Accessed 2010 Oct 11]
Philips Z, Ginnelly L, Sculpher M, et al. Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess 2004; 8(36): iii–iv, ix-xi, 1-158
Bradbury PA, Tu D, Seymour L, et al. Economic analysis: randomized placebo-controlled clinical trial of erlotinib in advanced non-small cell lung cancer. J Natl Cancer Inst 2010 Mar 3; 102(5): 298–306
Carlson JJ, Reyes C, Oestreicher N, et al. Comparative clinical and economic outcomes of treatments for refractory non-small cell lung cancer (NSCLC). Lung Cancer 2008 Sep; 61 (3): 405–15
Holmes J, Dunlop D, Hemmett L, et al. A cost-effectiveness analysis of docetaxel in the second-line treatment of non-small cell lung cancer. Pharmacoeconomics 2004; 22 (9): 581–9
Klein R, Muehlenbein C, Liepa AM, et al. Cost-effectiveness of pemetrexed plus cisplatin as first-line therapy for advanced nonsquamous non-small cell lung cancer. J Thorac Oncol 2009 Nov; 4 (11): 1404–14
Klein R, Wielage R, Muehlenbein C, et al. Cost-effectiveness of pemetrexed as first-line maintenance therapy for advanced nonsquamous non-small cell lung cancer. J Thorac Oncol 2010 Aug; 5 (8): 1263–72
Lees M, Aristides M, Maniadakis N, et al. Economic evaluation of gemcitabine alone and in combination with cisplatin in the treatment of nonsmall cell lung cancer. Pharmacoeconomics 2002; 20 (5): 325–37
Leighl NB, Shepherd FA, Kwong R, et al. Economic analysis of the TAX 317 trial: docetaxel versus best supportive care as second-line therapy of advanced non-small-cell lung cancer. J Clin Oncol 2002 Mar 1; 20 (5): 1344–52
Lewis G, Peake M, Aultman R, et al. Cost-effectiveness of erlotinib versus docetaxel for second-line treatment of advanced non-small-cell lung cancer in the United Kingdom. J Int Med Res 2010 Jan; 38 (1): 9–21
Asukai Y, Valladares A, Camps C, et al. Cost-effectiveness analysis of pemetrexed versus docetaxel in the second-line treatment of non-small cell lung cancer in Spain: results for the non-squamous histology population. BMC Cancer 2010 Jan; 10: 26
Neymark N, Lianes P, Smit EF, et al. Economic evaluation of three two-drug chemotherapy regimens in advanced non-small-cell lung cancer. Pharmacoeconomics 2005; 23 (11): 1155–66
Clegg A, Scott DA, Sidhu M, et al. A rapid and systematic review of the clinical effectiveness and cost-effectiveness of paclitaxel, docetaxel, gemcitabine and vinorelbine in non-small-cell lung cancer. Health Technol Assess 2001; 5 (32): 1–195
Dranitsaris G, Cottrell W, Evans WK. Cost-effectiveness of chemotherapy for nonsmall-cell lung cancer. Curr Opin Oncol 2002 Jul; 14 (4): 375–83
Carlson JJ, Veenstra DL, Ramsey SD. Pharmacoeconomic evaluations in the treatment of non-small cell lung cancer. Drugs 2008; 68 (8): 1105–13
Chouaid C, Atsou K, Hejblum G, et al. Economics of treatments for non-small cell lung cancer. Pharmacoeconomics 2009; 27 (2): 113–25
Carlson JJ. Erlotinib in non-small-cell lung cancer: a review of the clinical and economic evidence. Expert Rev Pharmacoecon Outcomes Res 2009 Oct; 9 (5): 409–16
Lyseng-Williamson KA. Erlotinib: a pharmacoeconomic review of its use in advanced non-small cell lung cancer. Pharmacoeconomics 2010; 28 (1): 75–92
Maniadakis N, Fragoulakis V, Pallis A, et al. Economic evaluation of docetaxel/gemcitabine versus docetaxel as frontline treatment of patients with advanced/metastatic non-small cell lung cancer in Greece. Lung Cancer 2007 Nov; 58 (2): 275–81
Smit EF, van Meerbeeck JP, Lianes P, et al. Three-arm randomized study of two cisplatin-based regimens and paclitaxel plus gemcitabine in advanced non-small-cell lung cancer: a phase III trial of the European Organization for Research and Treatment of Cancer Lung Cancer Group —EORTC 08975. J Clin Oncol 2003 Nov 1; 21 (21): 3909–17
Comella P, Frasci G, Panza N, et al. Randomized trial comparing cisplatin, gemcitabine, and vinorelbine with either cisplatin and gemcitabine or cisplatin and vinorelbine in advanced non-small-cell lung cancer: interim analysis of a phase III trial of the Southern Italy Cooperative Oncology Group. J Clin Oncol 2000 Apr; 18 (7): 1451–7
Schiller JH, Harrington D, Belani CP, et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med 2002 Jan 10; 346 (2): 92–8
Georgoulias V, Papadakis E, Alexopoulos A, et al. Platinum-based and non-platinum-based chemotherapy in advanced non-small-cell lung cancer: a randomised multi-centre trial. Lancet 2001 May 12; 357 (9267): 1478–84
Cleemput I, Neyt M, Thiry N, et al. Threshold values for cost-effectiveness in health care. Brussels: KCE, 2008. Report no. 100C
Scagliotti GV, Parikh P, von Pawel J, et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol 2008 Jul 20; 26 (21): 3543–51
Shepherd FA, Dancey J, Ramlau R, et al. Prospective randomized trial of docetaxel versus best supportive care in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy. J Clin Oncol 2000 May; 18 (10): 2095–103
Hanna N, Shepherd FA, Fossella FV, et al. Randomized phase III trial of pemetrexed versus docetaxel in patients with non-small-cell lung cancer previously treated with chemotherapy. J Clin Oncol 2004 May 1; 22 (9): 1589–97
Shepherd FA, Rodrigues PJ, Ciuleanu T, et al. Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med 2005 Jul 14; 353 (2): 123–32
Fossella FV, DeVore R, Kerr RN, et al. Randomized phase III trial of docetaxel versus vinorelbine or ifosfamide in patients with advanced non-small-cell lung cancer previously treated with platinum-containing chemotherapy regimens. The TAX 320 Non-Small Cell Lung Cancer Study Group. J Clin Oncol 2000 Jun; 18 (12): 2354–62
Drummond MF, Sculpher MJ, Torrance GW, et al. Methods for the economic evaluation of health care programmes. 3rd ed. Oxford: Oxford University Press, 2005
Mok TS, Wu YL, Thongprasert S, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 2009 Sep 3; 361 (10): 947–57
Chouaid C, Monnet I, Robinet G, et al. Economic impact of gefitinib for refractory non-small-cell lung cancer: a Markov model-based analysis. Curr Med Res Opin 2007 Jul; 23 (7): 1509–15
Azzoli CG, Baker Jr S, Temin S, et al. American Society of Clinical Oncology clinical practice guideline update on chemotherapy for stage IV non-small-cell lung cancer. J Clin Oncol 2009 Dec 20; 27 (36): 6251–66
Bradley CJ, Yabroff KR, Dahman B, et al. Productivity costs of cancer mortality in the United States: 2000–2020. J Natl Cancer Inst 2008 Dec 17; 100 (24): 1763–70
Garau M, Shah KK, Mason AR, et al. Using QALYs in cancer: review of the methodological limitations. London: Office of Health Economics, 2010 Oct 26. Report no. 10/01
Sturza J. A review and meta-analysis of utility values for lung cancer. Med Decis Making 2010 Nov; 30 (6): 685–93
Barbieri M, Drummond M, Willke R, et al. Variability of cost-effectiveness estimates for pharmaceuticals in Western Europe: lessons for inferring generalizability. Value Health 2005 Jan; 8 (1): 10–23
Anderson R. Systematic reviews of economic evaluations: utility or futility?. Health Econ 2010 Mar; 19 (3): 350–64
Jack B, Boland A, Dickson R, et al. Best supportive care in lung cancer trials is inadequately described: a systematic review. Eur J Cancer Care (Engl) 2010 May; 19 (3): 293–301
Acknowledgements
This research was supported by The Netherlands Organization for Health Research and Development (Zorg Onderzoek Nederland Medische Wetenschappen; Zonmw) [Zonmw grant 50-50110-96-474]. Zonmw was not involved in the design and conduct of the study; collection, management, analysis and interpretation of the data; or preparation, review or approval of the manuscript. The publication of the study results is not contingent on the sponsor’s approval or censorship of the manuscript.
The authors have no conflicts of interest that are directly relevant to the content of this article.
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Bongers, M.L., Coupé, V.M.H., Jansma, E.P. et al. Cost Effectiveness of Treatment with New Agents in Advanced Non-Small-Cell Lung Cancer. PharmacoEconomics 30, 17–34 (2012). https://doi.org/10.2165/11595000-000000000-00000
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DOI: https://doi.org/10.2165/11595000-000000000-00000