Cost-effectiveness of pemetrexed as first-line maintenance therapy for advanced nonsquamous non-small cell lung cancer.

INTRODUCTION: The primary objective was to estimate the cost-effectiveness of maintenance therapy with pemetrexed (Pem) compared with observation, each with best supportive care, in patients with advanced non-small cell lung cancer (NSCLC) who have completed, without progression, at least four cycles of first-line platinum chemotherapy, particularly in those with nonsquamous cell histology. Secondary comparisons included Pem with erlotinib (Erl) or Pem with bevacizumab (Bev). METHODS: A semi-Markov model was developed to compare the 3-year impact of Pem with three other alternatives for maintenance therapy from a United States payer perspective. Data from randomized controlled clinical trials provided clinical inputs. Medicare reimbursement rates were used to determine drug costs. A retrospective claims database analysis was used to obtain estimates of other direct NSCLC-related costs. RESULTS: In the prespecified subset of patients with nonsquamous cell histology only, the incremental cost per life-year gained was $122,371 for Pem to observation and $150,260 for Pem to Erl, and Bev was dominated by Pem. In all patients with advanced NSCLC regardless of histologic subtype, using Pem as maintenance therapy led to an incremental cost per life-year gained of $205,597 compared with observation and $312,341 compared with Erl. CONCLUSIONS: Compared with observation and other agents used and/or reimbursed for maintenance therapy in advanced NSCLC, Pem may be considered cost-effective, particularly in patients with nonsquamous cell histology. This analysis is the first to evaluate the cost-effectiveness of maintenance therapy in advanced NSCLC and emphasizes the importance of histology in identifying the appropriate patient for Pem maintenance therapy.

Cost-effectiveness of pemetrexed plus cisplatin as first-line therapy for advanced nonsquamous non-small cell lung cancer.

INTRODUCTION: To estimate the cost-effectiveness of first-line cisplatin/pemetrexed (Cis/Pem) compared with cisplatin/gemcitabine (Cis/Gem), carboplatin/paclitaxel (Carb/Pac), and carboplatin/paclitaxel/bevacizumab (Carb/Pac/Bev) in patients with advanced non-small cell lung cancer (NSCLC), particularly in those with nonsquamous cell histology (i.e., adenocarcinoma, large cell carcinoma, or histology not otherwise specified). METHODS: A semi-Markov model was developed to compare the 2-year impact of Cis/Pem to three other first-line regimens from the U.S. payer perspective. Data from the randomized controlled clinical trial of Cis/Pem versus Cis/Gem and a mixed treatment comparison model (no head-to-head data were available for the Cis/Pem to Carb/Pac or Carb/Pac/Bev comparisons) provided clinical inputs. Medicare reimbursement rates were used to determine drug costs. A retrospective claims database analysis was used to obtain estimates of other direct NSCLC-related costs. RESULTS: In all patients with advanced NSCLC regardless of histologic subtype, using Cis/Pem as first-line chemotherapy led to an incremental cost per life-year gained (LYG) of $104,577 for Cis/Pem to Cis/Gem and $231,291 for Cis/Pem to Carb/Pac. In the prespecified subset of patients with nonsquamous cell histology, the incremental cost per LYG was $83,537 for Cis/Pem to Cis/Gem and $178,613 for Cis/Pem to Carb/Pac. The incremental cost per LYG for Carb/Pac/Bev to Cis/Pem was more than $300,000. CONCLUSIONS: Compared with commonly used and reimbursed regimens for first-line chemotherapy in advanced NSCLC, Cis/Pem may be considered cost-effective, particularly in patients with nonsquamous cell histology. This analysis emphasizes the importance of histology in identifying the appropriate patient for Cis/Pem first-line chemotherapy.