CN4: ECONOMIC EVALUATION OF GEMZAR/CISPLATIN RELATIVE TO OTHER CISPLATIN BASED TREATMENTS FOR NON SMALL CELL LUNG (NSCLC) CANCER IN THE UK

OBJECTIVES: Lung cancer is a leading cause of morbidity and mortality. Chemotherapy is a main treatment option but its availability in the UK is limited and not consistent across geographical regions. This study reports on an economic evaluation of Gemzar/cisplatin (GC) relative to: mitomycin/ifosfamide/cisplatin (MIC), etoposide/cisplatin (PE) and itomycin/vinblastine/cisplatin (MVP). These represent standard platinum-containing regimens that are currently used in the UK. METHODS: The study perspective is that of the UK-NHS. Data were derived from comparative clinical trials (Crino et al 1999, Cardenal et al. 1997, Costa 2000). Costing is based on: chemotherapy, infusion, hospitalisations, visits to health care professionals and concomitant medications. Resource utilisation from the trials was combined with unit cost data from various UK sources. Costs correspond to 2000. Time horizon for the estimation of costs is one year; hence discounting was unnecessary. Treatment effectiveness is measured by overall survival and objective tumour response. RESULTS: In the first setting the cost-per-patient on GC was £5,101 and on MIC £4,481. Overall tumour response rates were 39.6% and 27.6% respectively. Thus, the incremental cost-per-tumour-response of GC was £5,169. In the second setting, the cost on GC was £4,142 compared to £3,762 on PE. Overall tumour response was 40.6% and 21.9% respectively and progression-free life years 0.575 and 0.358. Thus, the incremental cost-per-tumour-response of GC was £2,032 and the incremental cost-per-progression-free-life-year £1,751. In the final setting, the cost of GC was £5,084 and of MVP £4,004. Overall tumour response was 54.0% and 36.7% and one year survival 36% and 17% respectively. The incremental cost-per-tumour-response of GC was £6,240 and the incremental cost-per-survivor-at-one-year was £5,681. In extreme changes to underlying variables the above ratios vary from dominance to a maximum of £14,000. CONCLUSIONS: These results demonstrate that Gemzar/cisplatin represents a relatively cost-effective treatment for NSCLC with ratios comparable of below those of therapies currently in use within the NHS.