부산대학교 도서관

Objective: To compare the efficiency of therapy with erlotinib (ERL), docetaxel (DOC), pemetrexed (PEM) or best supportive care (BSC) in patients with advanced non-small cell lung cancer (NSCLC) who have failed previous chemotherapy regimens.Methods: Cost-minimization and cost-utility analyses were performed with a Markov model with 3 health states: initial, disease progression and dead. The evolution of a cohort of patients was simulated along 2 years (monthly cycles). Subpopulations analyzed: second line treatment (base case), second and third-line (ECOG 0–1 or not) and third-line only. Survival and time to progression were obtained from 3 clinical trials. Quality adjusted life years (QALY) were obtained from a study performed in 154 patients. National Health System (NHS) perspective (direct health costs) was applied. Resources used were estimated from a panel of Spanish oncologists and from the literature. Unit costs were derived from Spanish databases (€ March 2006). Annual discount rate: 3.5% (costs and utilities). Sensitivity analyses for subpopulations, 3 years results (Weibull and Loglogistic distributions) and probabilistic (Monte Carlo) were performed.Results: After 2 years more QALY per patient were obtained with ERL (0.24) than with DOC (0.23) and BSC (0.18). No differences versus PEM were observed. The total cost per patient was lower with ERL (17,838 €) than with DOC (20,392 €;–2,554 €) or PEM (27,317 €;–9,479 €) and higher than with BSC (8,198 €; + 9,640 €). ERL was the “dominant” treatment (more efficacy and lower costs) versus DOC and resulted in a cost saving versus PEM. Additional cost per QALY or life year gained (LYG) with ERL versus BSC: 160,667 € and 56,706 €, respectively. Additional cost per QALY gained with DOC and PEM versus BSC were higher than with ERL: 243,880 € and 318,650 €, respectively; additional cost per LYG with DOC and PEM were also higher than with ERL: 71,729 € and 112,465 €, respectively. The sensitivity analysis confirmed the robustness of the base case analysis. If 1,000 NSCLC patients were treated with ERL, the annual saving for NHS (substitution rates: 5%–65%) would range between 123,000–1,600,000 € (DOC replacement) and 448,000–5,831,000 € (PEM replacement).Conclusions: According to this model, treatment with ERL of advanced previously treated NSCLC is more cost-effective than with DOC and PEM, with savings for the NHS.