Economic analysis of a randomized phase III trial of gemcitabine plus vinorelbine compared with cisplatin plus vinorelbine or cisplatin plus gemcitabine for advanced non-small-cell lung cancer (Italian GEMVIN3/NCIC CTG BR14 trial)

• Published in: Lung cancer (Amsterdam, Netherlands) Vol. 82; no. 1; pp. 115 - 120
• Main Authors: Reaume, M. Neil, Leighl, Natasha B, Mittmann, Nicole, Coyle, Doug, Hirsh, Vera, Seymour, Lesley, Tu, Dongsheng, Shepherd, Frances A, Graham, Barbara, Gridelli, Cesare, Perrone, Francesco, Di Maio, Massimo, Bradbury, Penelope A, Evans, William K
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ireland Ltd 01.10.2013; Elsevier
• Subjects: Antineoplastic Combined Chemotherapy Protocols - economics; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - economics; Carcinoma, Non-Small-Cell Lung - mortality; Cisplatin - administration & dosage; Clinical Trials, Phase III as Topic; Cost consequence; Cost-Benefit Analysis; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Economic analysis; Hematology, Oncology and Palliative Medicine; Humans; Lung Neoplasms - drug therapy; Lung Neoplasms - economics; Lung Neoplasms - mortality; Medical sciences; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Staging; Non-platinum doublet; Non-small cell lung cancer; Platinum doublet; Pneumology; Pulmonary/Respiratory; Randomized Controlled Trials as Topic; Retrospective Studies; Survival Analysis; Treatment Outcome; Tumors; Tumors of the respiratory system and mediastinum; Vinblastine - administration & dosage; Vinblastine - analogs & derivatives; Italy; Europe; Economic analysis; Cost consequence; Platinum doublet; Non-small cell lung cancer; Non-platinum doublet; Antineoplastic agent; Phase III trial; Costs; Italian; Gemcitabine; Lung cancer; non-small cell lung carcinoma; Randomization; Platinum; Bronchus disease; Clinical trial; Advanced stage; Public health; Lung disease; Drug combination; Respiratory disease; Malignant tumor; Cisplatin; Health economy; Carboplatin; Economic aspect; Comparative study; Vinorelbine; Cancer
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2013.07.012

Abstract Background/objective Non-platinum-based chemotherapy is a potential alternative to platinum doublet therapy for advanced non-small cell lung cancer in selected patients. We determined the cost-effectiveness of gemcitabine/vinorelbine (GEMVIN), versus cisplatin/gemcitabine (PG) or cisplatin/vinorelbine (PV), from a government payer perspective. Methods Results from a randomized trial of GEMVIN versus PG or PV demonstrated no significant difference in global quality of life (primary endpoint) or overall survival between regimens, but superior progression-free survival for platinum-based regimens. A cost analysis was conducted using direct medical costs of treatment, grade 3 or 4 toxicity management, and investigations for the mean number of cycles per study arm. Costs were calculated using Canadian dollars in 2005, and then in 2013 after drug patent expiry. Results In 2005, GEMVIN was the most expensive regimen ($6868), and PV the least expensive ($4650), with an incremental cost of GEMVIN over PV of $2218. Diagnostic and administration costs did not differ significantly among regimens; GEMVIN had the lowest toxicity costs. The principal cost driver in 2005 was the cost of chemotherapy. In 2013, toxicity and administration costs emerged as major drivers; GEMVIN was less costly than PV and PG, (cost savings of $413 over PV). Conclusion Despite similar outcomes, GEMVIN was more expensive than PV or PG in 2005 because of higher chemotherapy costs. By 2013, after chemotherapy drug patent expiry, GEMVIN became the least costly regimen. Economic considerations in oncology change over time, and should be revisited in policy decisions based on cost.