Cost-effectiveness of pemetrexed as first-line maintenance therapy for advanced nonsquamous non-small cell lung cancer

Robert Klein, Ron Wielage, Catherine Muehlenbein, Astra M. Liepa, Steve Babineaux, Anthony Lawson, Lee Schwartzberg

Research output: Contribution to journalArticle

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Abstract

Introdution: The primary objective was to estimate the cost-effectiveness of maintenance therapy with pemetrexed (Pem) compared with observation, each with best supportive care, in patients with advanced non-small cell lung cancer (NSCLC) who have completed, without progression, at least four cycles of first-line platinum chemotherapy, particularly in those with nonsquamous cell histology. Secondary comparisons included Pem with erlotinib (Erl) or Pem with bevacizumab (Bev). Methods:A semi-Markov model was developed to compare the 3-year impact of Pem with three other alternatives for maintenance therapy from a United States payer perspective. Data from randomized controlled clinical trials provided clinical inputs. Medicare reimbursement rates were used to determine drug costs. A retrospective claims database analysis was used to obtain estimates of other direct NSCLC-related costs. Results: In the prespecified subset of patients with nonsquamous cell histology only, the incremental cost per life-year gained was $122,371 for Pem to observation and $150,260 for Pem to Erl, and Bev was dominated by Pem. In all patients with advanced NSCLC regardless of histologic subtype, using Pem as maintenance therapy led to an incremental cost per life-year gained of $205,597 compared with observation and $312,341 compared with Erl. Conclusions: Compared with observation and other agents used and/or reimbursed for maintenance therapy in advanced NSCLC, Pem may be considered cost-effective, particularly in patients with nonsquamous cell histology. This analysis is the first to evaluate the cost-effectiveness of maintenance therapy in advanced NSCLC and emphasizes the importance of histology in identifying the appropriate patient for Pem maintenance therapy.

Original languageEnglish (US)
Pages (from-to)1263-1272
Number of pages10
JournalJournal of Thoracic Oncology
Volume5
Issue number8
DOIs
StatePublished - Jan 1 2010

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Pemetrexed
Non-Small Cell Lung Carcinoma
Cost-Benefit Analysis
Histology
Observation
Therapeutics
Costs and Cost Analysis
Insurance Claim Review
Drug Costs
Complementary Therapies
Medicare
Platinum

All Science Journal Classification (ASJC) codes

  • Oncology
  • Pulmonary and Respiratory Medicine

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Cost-effectiveness of pemetrexed as first-line maintenance therapy for advanced nonsquamous non-small cell lung cancer. / Klein, Robert; Wielage, Ron; Muehlenbein, Catherine; Liepa, Astra M.; Babineaux, Steve; Lawson, Anthony; Schwartzberg, Lee.

In: Journal of Thoracic Oncology, Vol. 5, No. 8, 01.01.2010, p. 1263-1272.

Research output: Contribution to journalArticle

Klein, Robert ; Wielage, Ron ; Muehlenbein, Catherine ; Liepa, Astra M. ; Babineaux, Steve ; Lawson, Anthony ; Schwartzberg, Lee. / Cost-effectiveness of pemetrexed as first-line maintenance therapy for advanced nonsquamous non-small cell lung cancer. In: Journal of Thoracic Oncology. 2010 ; Vol. 5, No. 8. pp. 1263-1272.
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