Health state utilities for non small cell lung cancer.

BACKGROUND: Existing reports of utility values for metastatic non-small cell lung cancer (NSCLC) vary quite widely and are not all suitable for use in submissions in the UK. The aim of this study was to elicit UK societal based utility values for different stages of NSCLC and different grade III-IV toxicities commonly associated with chemotherapy treatments. Toxicities included neutropenia, febrile neutropenia, fatigue, diarrhoea, nausea and vomiting, rash and hair loss. METHODS: Existing health state descriptions of metastatic breast cancer were revised to make them suitable as descriptions of metastatic NSCLC patients on second-line treatment. The existing health states were used in cognitive debrief interviews with oncologists (n = 5) and oncology specialist nurses (n = 5). Changes were made as suggested by the clinical experts. The resulting health states (n = 17) were piloted and used in a societal based valuation study (n = 100). Participants rated half of the total health states in a standard gamble interview to derive health state utility scores. Data were analysed using a mixed model analysis. RESULTS: Each health state described the symptom burden of disease and impact on different levels of functioning (physical, emotional, sexual, and social). The disutility related to each disease state and toxicity was estimated and were combined to give health state values. All disease states and toxicities were independent significant predictors of utility (p < 0.001). Stable disease with no toxicity (our base state) had a utility value of 0.653. Utility scores ranged from 0.673 (responding disease with no toxicity) to 0.473 for progressive disease. CONCLUSION: This study reflects the value that society place on the avoidance of disease progression and severe toxicities in NSCLC.

Retrospective cost analysis of gemcitabine in combination with cisplatin in non-small cell lung cancer compared to other combination therapies in Europe.

In two recent randomised trials, gemcitabine plus cisplatin (Gem/Cis) was found to be at least as effective as vinorelbine plus cisplatin (Vin/Cis), paclitaxel plus cisplatin (Pac/Cis), paclitaxel plus carboplatin (Pac/Carbo), or docetaxel plus cisplatin (Doc/Cis) in patients with advanced non-small cell lung cancer (NSCLC). In cost-minimisation analyses of these studies from the perspectives of the national health services of five European countries (France, Germany, Italy, Spain, UK), Gem/Cis was associated with lower average treatment-related costs than Vin/Cis, Pac/Cis, and Pac/Carbo, and similar or lower costs than Doc/Cis. The incremental cost savings per patient of Gem/Cis compared to Vin/Cis ranged from 827 Euro to 2055 Euro per patient and from 1616 Euro to 5342 Euro compared to the paclitaxel-containing regimens. Overall, results were generally similar between countries, and were robust to univariate sensitivity analyses. Although differences in healthcare systems mean that the results may not be generalisable to all countries/settings, these results provide an economic rationale for the use of Gem/Cis as a first-line treatment option in Europe for patients with NSCLC.

Cost-utility analysis of the GC versus MVAC regimens for the treatment of locally advanced or metastatic bladder cancer.

A cost-utility analysis was conducted to compare the gemcitabine (Gemzar)/cisplatin and methotrexate/vinblastine(Velban)/doxorubicin (Doxil)/cisplatin regimens in the treatment of locally advanced or metastatic bladder cancer. The analysis combined the results of a cost analysis of a head-to-head Phase III clinical trial with those from a cross-sectional utility study. The analysis was performed from the perspective of the National Health Service in England and Wales. Medical resource use was obtained from the clinical trial database, from which patient-level cost streams were estimated for each treatment group. Unit costs for each resource utilization component were sought from the latest UK cost sources available at the time of analysis (2001). The distribution of the mean total and incremental costs for each group was simulated via bias-adjusted bootstrapping. Time trade-off utilities were derived from the utility study, which aimed to value the superior toxicity profile associated with gemcitabine/cisplatin, given comparable efficacy, in a discrete choice model assessing toxicity attributes and risks. The mean incremental cost of gemcitabine/cisplatin over methotrexate/vinblastine/doxorubicin/cisplatin was estimated to be approximately pound sterling 2976 per patient, based on a mean of 4.65 cycles per patient treated with gemcitabine/cisplatin compared with a mean of 3.92 cycles per methotrexate/vinblastine/doxorubicin/cisplatin patient. When combined with the utility estimates, this resulted in an incremental cost-effectiveness ratio of approximately pound sterling 22,925 per quality-adjusted life year gained associated with the choice of gemcitabine/cisplatin over methotrexate/vinblastine/doxorubicin/cisplatin. A 95% confidence interval for the incremental cost-effectiveness ratio was calculated to range from pound sterling 12,911 to 33,589 per quality-adjusted life year gained. The incremental cost of gemcitabine/cisplatin is primarily due to the direct costs of chemotherapy given minimal cost offsets. However, an incremental cost per quality-adjusted life year ratio in the range of pound sterling 20,000-30,000 per quality-adjusted life year gained suggested that the regimen is reasonable value for money in England and Wales.