Cost-utility analysis of maintenance therapy with gemcitabine or erlotinib vs observation with predefined second-line treatment after cisplatin–gemcitabine induction chemotherapy for advanced NSCLC: IFCT-GFPC 0502-Eco phase III study

BMC Cancer

Christos Chouaïd^1,14  Gérard Zalcman^1,13  Alain Vergnenegre^1,16  Sylvie Chabaud¹  Fabien Vaylet³  Michel Poudenx^1,15  Lionel Falchero^1,17  Pierre Fournel⁹  Hervé Le Caer⁵  Isabelle Monnet^1,11  Hervé Léna⁸  Jacky Crequit⁷  Virginie Westeel⁶  Pascal Dô^1,10  Laurent Greillier⁴  Armelle Lavolé^1,12  David Pérol¹  Maurice Pérol^1,18  Isabelle Borget² 

[1]Centre Léon Bérard, Lyon, France

[2]Études et Recherche en Économie de la Santé, Service de Biostatistique et d’Epidémiologie, Institut Gustave Roussy, 114, rue Edouard-Vaillant, 94805 Villejuif, Cedex, France

[3]Service des Maladies Respiratoires, HIA Percy, Clamart, France

[4]APHM, Hôpital Nord, Service d’Oncologie Multidisciplinaire et Innovations Thérapeutiques, Marseille, France

[5]Service de Pneumologie de Draguignan, Draguignan, France

[6]Service de Pneumologie, CHU Besançon, Besançon, France

[7]Service de Pneumologie, CH Creil, Creil, France

[8]Service de Pneumologie, CHU de Rennes, Rennes, France

[9]Département d'Oncologie Médicale, Institut de cancérologie Lucien Neuwith, Saint-Priest en Jarez, France

[10]Centre Régional de Lutte contre le Cancer François Baclesse, Caen, France

[11]Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France

[12]Hôpital Tenon, AP-HP, Paris, France

[13]Service de Pneumologie et Oncologie thoracique, Caen University Hospital, Caen, France

[14]Hôpital St-Antoine, APHP and UPMC University Paris 06, Paris, France

[15]Centre Régional de Lutte contre le Cancer Antoine Lacassagne, Nice, France

[16]Service de Pneumologie CHU de Limoges, Limoges, France

[17]Service de Pneumologie, Villefranche sur Saône, France

[18]Hospices Civils de Lyon, Lyon, France

关键词: Non-small-cell lung cancer;    Gemcitabine;    Erlotinib;    Maintenance therapy;    Cost-utility;   

Others  :  1117884
DOI  :  10.1186/1471-2407-14-953

 received in 2013-11-01, accepted in 2014-11-27,  发布年份 2014

【 摘 要 】

Background

The IFCT-GFPC 0502 phase III study reported prolongation of progression-free survival with gemcitabine or erlotinib maintenance vs. observation after cisplatin–gemcitabine induction chemotherapy for advanced non-small-cell lung cancer (NSCLC). This analysis was undertaken to assess the incremental cost-effectiveness ratio (ICER) of these strategies for the global population and pre-specified subgroups.

Methods

A cost-utility analysis evaluated the ICER of gemcitabine or erlotinib maintenance therapy vs. observation, from randomization until the end of follow-up. Direct medical costs (including drugs, hospitalization, follow-up examinations, second-line treatments and palliative care) were prospectively collected per patient during the trial, until death, from the primary health-insurance provider’s perspective. Utility data were extracted from literature. Sensitivity analyses were conducted.

Results

The ICERs for gemcitabine or erlotinib maintenance therapy were respectively 76,625 and 184,733 euros per quality-adjusted life year (QALY). Gemcitabine continuation maintenance therapy had a favourable ICER in patients with PS = 0 (52,213 €/QALY), in responders to induction chemotherapy (64,296 €/QALY), regardless of histology (adenocarcinoma, 62,292 €/QALY, non adenocarcinoma, 83,291 €/QALY). Erlotinib maintenance showed a favourable ICER in patients with PS = 0 (94,908 €/QALY), in patients with adenocarcinoma (97,160 €/QALY) and in patient with objective response to induction (101,186 €/QALY), but it is not cost-effective in patients with PS =1, in patients with non-adenocarcinoma or with stable disease after induction chemotherapy.

Conclusion

Gemcitabine- or erlotinib-maintenance therapy had ICERs that varied as a function of histology, PS and response to first-line chemotherapy.

【 授权许可】

   
2014 Borget et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

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