1219 - Cost-utility analysis of maintenance therapy with either gemcitabine or erlotinib versus observation with predefined second-line treatment after cis...

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Anti-Cancer Agents & Biologic Therapy
Bioethics, Legal, and Economic Issues
Non-Small-Cell Lung Cancer, Metastatic
Presenter Isabelle Borget
Authors I. Borget1, M. Perol2, D. Perol3, A. Lavole4, L. Greillier5, R. Gervais6, G. Zalcman7, S. Chabaud8, A. Vergnenegre9, C. Chouaid10
  • 1Biostatistics And Epidemiology, institut Gustave Roussy, 94805 - Villejuif/FR
  • 2Medical Oncology, Centre L, FR-69008 - Lyon CEDEX/FR
  • 3Biostatistics Unit, Centre L, FR-69008 - Lyon CEDEX/FR
  • 4Pneumology, Hopital Tenon, Paris/FR
  • 5Multidisciplinary Oncology & Therapeutic Innovations, Aix-Marseille Univ, Assistance Publique-Hôpitaux de Marseille, Marseille/FR
  • 6Pneumology, Centre François Baclesse, Caen/FR
  • 7Service De Pneumologie, C.H.U. de Caen, FR-14033 - Caen CEDEX 9/FR
  • 8Ubet, Centre Leon Berard, Lyon/FR
  • 9Service De Pneumologie, Hopital du CluzeauCHU Dupuytren, FR-87042 - Limoges CEDEX 1/FR
  • 10Pneumologie, Hopital Saint-Antoine, 75012 - Paris/FR

Abstract

Rationale

The IFCT–GFPC 0502 phase III reported prolongation of progression-free survival with maintenance with either gemcitabine or erlotinib versus observation after cisplatin-gemcitabine chemotherapy in advanced NSCLC. Their incremental cost-effectiveness ratio (ICER) was assessed in global population and in pre specified sub-groups.

Methods

A cost-utility analysis was performed to evaluate ICER of maintenance therapy with either gemcitabine or erlotinib, compared to observation. Direct medical costs (drugs costs, hospitalization, examinations, second-line treatments and palliative costs) were prospectively collected per patient alongside the trial, until death, from the third party payer perspective. Utility were extracted from literature. Sensitivity analyses were performed.

Results

ICER for maintenance therapy with gemcitabine and erlotinib were respectively 76 625 and 184 733 €/quality-adjusted life years (QALY). Gemcitabine maintenance therapy had favourable ICER in patients with PS = 0 (52 213 €/QALY), in responders to induction chemotherapy (64 296 €/QALY) and in patients with adenocarcinoma (62 292 €/QALY); erlotinib had favourable ICER if PS = 0 (94 908 €/QALY), in patients with adenocarcinoma (97 160 €/QALY) and objective response to induction (101,186 €/QALY), but it is not cost-effective in patients with PS = 1, other histology or if stable disease.

Conclusion

Gemcitabine and erlotinib maintenance therapy have acceptable ICER but with wide variation, function of histology, PS and response to the first line chemotherapy.

Disclosure

I. Borget: Honoraria from Roche for set up a class in health economy (no relation with the present study).

M. Perol: consultant or advisory board with Roche, Lilly (myself) Honoraria from Lilly, Roche, Pfizer, Boehringer Ingelheim (myself) Research funding from Lilly, Roche (myself).

D. Perol: Honoraria : Roche (myself).

G. Zalcman: Honoraria from Lilly, Roche Research funding from Lilly, Roche.

A. Vergnenegre: honoraria and research funding from Roche.

C. Chouaid: Honoraria from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Hoffman la Roche, Astra Zeneka, Sanofi Aventis, Lilly, Novartis and Amgen Research funding from AstraZeneca, Lilly, Novartis and Amgen.

All other authors have declared no conflicts of interest.