1303P - Cost effectiveness of pemetrexed/cisplatin (PEM/CIS) in the treatment of advanced, non-squamous, non-small cell lung cancer (NSQNSCLC) patients

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Bioethics, Legal, and Economic Issues
Non-Small-Cell Lung Cancer, Metastatic
Presenter Katherine Winfree
Authors K.B. Winfree1, M. Shah2, P. Peterson3, S. Gruschkus2, M. Eaddy2, M. Green2
  • 1Eli Lilly and Company, Indianapolis/US
  • 2Oncology, Xcenda AmerisourceBergen Consulting Services, Palm Harbor/US
  • 3Oncology Statistics, Eli Lilly and Company, Indianapolis/US

Abstract

Purpose

Pem/cis is indicated for 1st line therapy in patients (pts) with advanced, nsqNSCLC. Data from community practices provide an opportunity to evaluate the cost effectiveness (CE) of Pem/cis relative to other 1st line regimens.

Methods

Advanced nsqNSCLC pts receiving 1st line therapy with Pem/cis, carboplatin/paclitaxel + bevacizumab (C/P + B), or carboplatin/paclitaxel (C/P) from 2006–2009 were identified through EMRs of 20 large US community oncology practices. Pts were matched by stage, ECOG performance status (PS), gender, age, and index year. Progression-free survival (PFS)/overall survival (OS) were calculated and treatment effect was assessed via Kaplan-Meier and Cox regression analyses. Costs included chemotherapy, supportive care, and medical services. To evaluate CE, differences in costs/survival were calculated. Bootstrapping was used to estimate 95% confidence intervals (CIs) for mean differences and probability of falling within quadrants of CE plane.

Results

Each comparison had 78 matched pairs. Mean age was 64.1, 59.0% were male and 78.2% had PS = 0/1. Median PFS for pts treated with Pem/cis (128 days) was significantly longer than those treated with C/P + B (112 days; P = 0.007) or C/P (105 days; P = 0.004). Pts treated with Pem/cis had higher median OS, however not significant. Analyses of costs/PFS and costs/OS revealed greater effectiveness with less cost for Pem/cis compared to C/P + B (Tables).

Conclusions

Pts treated with Pem/cis experienced a significant PFS benefit and a trending OS benefit compared to C/P + B and C/P pts. Compared to C/P + B, Pem/cis yielded greater effectiveness with less cost.

Pem/cis vs C/P + B Pem/cis vs C/P
Mean D OS (95% CI) 30 days (-44.0, 98.6) 57 days (-8.4, 134.6)
Mean D Cost (95% CI) -$18,216 (-$33,306, -$3,889) $25,111 ($9,987, $30,627)
Probability Pem/cis is
less costly, more effective 83.7% 0%
more costly, more effective 1.0% 95.8%
Pem/cis vs C/P + B Pem/cis vs C/P
Mean D PFS (95% CI) 15 days (-53.3, 82.3) 39 days (-23.5, 99.7)
Mean D Cost (95% CI) -$17,603 (-$27,547, -$2,817 ) $25,583 ($15,601, $38,741)
Probability Pem/cis is
less costly, more effective 63.4% 0%
more costly, more effective 1.2% 89.4%
Disclosure

K.B. Winfree: I am an employee of and have stock ownership in Eli Lilly and Company.

M. Shah: Eli Lilly and Company sponsored this research study.

P. Peterson: I am an employee of and have stock ownership in Eli Lilly and Company.

S. Gruschkus: Eli Lilly and Company sposored this research study.

M. Eaddy: Eli Lilly and Company sposored this research study.

M. Green: On 3/16/12 I served as moderator for a Lilly Global Adv Board per my employment with Xcenda. Consistent with Lilly rules, the payments made to Xcenda for services will appear on the Lilly website delineating payments to physicians for services to Lilly.