Clinical Epidemiology and Ageing

Cost-utility analysis of maintenance therapy with gemcitabine or erlotinib vs observation with predefined second-line treatment after cisplatin-gemcitabine induction chemotherapy for advanced NSCLC: IFCT-GFPC 0502-Eco phase III study.

Borget I, Perol M, Pérol D, Lavole A, Greillier L, Do P, Westeel V, Crequit J, Lena H, Monnet I, Le Caer H, Fournel P, Falchero L, Poudenx M, Vaylet F, Chabaud S, Vergnenègre A, Zalcman G, Chouaid C BMC Cancer. 2014;14:953.

BACKGROUND: The IFCT-GFPC 0502 phase III study reported prolongation of progression-free survival with gemcitabine or erlotinib maintenance vs. observation after cisplatin-gemcitabine induction chemotherapy for advanced non-small-cell lung cancer (NSCLC). This analysis was undertaken to assess the incremental cost-effectiveness ratio (ICER) of these strategies for the global population and pre-specified subgroups.

METHODS: A cost-utility analysis evaluated the ICER of gemcitabine or erlotinib maintenance therapy vs. observation, from randomization until the end of follow-up. Direct medical costs (including drugs, hospitalization, follow-up examinations, second-line treatments and palliative care) were prospectively collected per patient during the trial, until death, from the primary health-insurance provider's perspective. Utility data were extracted from literature. Sensitivity analyses were conducted.

RESULTS: The ICERs for gemcitabine or erlotinib maintenance therapy were respectively 76,625 and 184,733 euros per quality-adjusted life year (QALY). Gemcitabine continuation maintenance therapy had a favourable ICER in patients with PS = 0 (52,213 €/QALY), in responders to induction chemotherapy (64,296 €/QALY), regardless of histology (adenocarcinoma, 62,292 €/QALY, non adenocarcinoma, 83,291 €/QALY). Erlotinib maintenance showed a favourable ICER in patients with PS = 0 (94,908 €/QALY), in patients with adenocarcinoma (97,160 €/QALY) and in patient with objective response to induction (101,186 €/QALY), but it is not cost-effective in patients with PS =1, in patients with non-adenocarcinoma or with stable disease after induction chemotherapy.

CONCLUSION: Gemcitabine- or erlotinib-maintenance therapy had ICERs that varied as a function of histology, PS and response to first-line chemotherapy.

MeSH terms: Adult; Aged; Antineoplastic Agents; Carcinoma, Non-Small-Cell Lung; Cisplatin; Cost-Benefit Analysis; Deoxycytidine; Erlotinib Hydrochloride; Female; Health Care Costs; Humans; Induction Chemotherapy; Lung Neoplasms; Maintenance Chemotherapy; Male; Middle Aged; Prospective Studies; Quality-Adjusted Life Years; Quinazolines; Survival Analysis
DOI: 10.1186/1471-2407-14-953