Table 7.
Comparison in cost-effectiveness of direct medical cost between maintenance with pemetrexed vs. observation alone after induction chemotherapy: study designs and results
| Reference | Methods, costs and outcomes discount, study perspective, time frame and reference year for cost | Data sources | Study population | Regime | Cost | LYG or OS | QALY | ICERa/LYG | ICERa/QALY |
|---|---|---|---|---|---|---|---|---|---|
| Greenhalgh et al19 (UK) | ERG report reviewing the manufacturer’s evidence submission, de novo economic model Cost discount ND Time frame; lifetime Reference year; ND |
Clinical parameters: RCT (JMEN trial) | Subgroup of 481 patients in JMEN trial | PEM maintenance | 15.5 M | ||||
| Submitted base caseb | £17,455 | 0.9697 | ND | £33,732 | |||||
| Combined effect of changes | £20,925 | 0.9539 | ND | £47,239 | |||||
| BSC alone | 10.3 M | ||||||||
| Submitted base caseb | £8,318 | 0.6988 | |||||||
| Combined effect of changes | £8,370 | 0.6881 | |||||||
| Klein et al20 (US) | Semi-Markov model Discounted at 3% US payer’s perspective Time frame; 3 years Reference; 2009 US$ |
Clinical parameters: RCT (JMEN, ATLAS, SATURN trials) Cost: Medicare reimbursement rate and analysis of claim database (PharMetrics) |
Advanced NSCLC patients who have completed first-line platinum double chemotherapy without progression | PEM maintenance | |||||
| Non-SQ | $96,774 | 1.3412 Y | $122,371 | ||||||
| All NSCLC | $89,289 | 1.2434 Y | $205,597 | ||||||
| BSC alone | ND | ND | |||||||
| Non-SQ | $64,830 | 1.0802 Y | |||||||
| All NSCLC | $61,036 | 1.1060 Y | |||||||
| Tsuchiya et al22 (Japan) | Markov model Discounted at 3% annually Japanese healthcare payer perspective Time frame; ND Reference; 2009 US$ (assumed US $1 to JPY 115) |
Clinical parameters: RCT (JMEN trial) | Advanced NSCLC (either non-SQ or all histology), Japanese men in their 60s, height 164.6 cm, weight 64.5 kg, BSA 1.70 m2 | PEM maintenance | |||||
| Non-SQ | $68,536 | 489.4 D | 0.7321 | $80,563 | $150,115 | ||||
| All NSCLC | $64,409 | 451.8 D | 0.6770 | $109,024 | $203,022 | ||||
| BSC alone | |||||||||
| Non-SQ | $39,872 | 359.5 D | 0.5411 | ||||||
| All NSCLC | $38,843 | 366.2 D | 0.5511 | ||||||
| Matter-Walstra et al21 (Switzerland) | Markov model No discount Swiss health care system perspective Time frame; lifetime Reference; 2010 Swiss prices (€0.72 / Swiss franc) |
Clinical parameters: RCT (JMEN trial) Cost: literature | Advanced non-SQ NSCLC, BSA 1.77 m2 |
PEM maintenance | €99,705 | 15.6 M | 0.82 | ND | €106,202 |
| BSC alone | €71,316 | 10.7 M | 0.56 | ||||||
| Zeng et al23 (People’ Republic of China) | Markov model Discounted at 3% annually Chinese health care system perspective Time frame; 1,2,5 and 10 year Reference; 2010 US$ (assumed 1 US$ to 6.6515 Chinese yuan) |
Clinical parameters: RCT (PARAMOUNT trial) Cost: BSC and AE costs from literature, market share and local charges in the People’s Republic of China |
Advanced non-SQ NSCLC, weight 65 kg, BSA 1.72 m2 |
PEM maintenance | |||||
| 1-year | $36,443 | 0.760 Y | 0.440 | $193,796 | $183,589 | ||||
| 2-year | $55,532 | 1.140 Y | 0.631 | $99,183 | $126,353 | ||||
| 5-year | $72,103 | 1.444 Y | 0.776 | $80,792 | $124,766 | ||||
| 10-year | $73,955 | 1.477 Y | 0.791 | $79,134 | $124,793 | ||||
| BSC alone | |||||||||
| 1-year | $28,255 | 0.718 Y | 0.396 | ||||||
| 2-year | $44,181 | 1.026 Y | 0.541 | ||||||
| 5-year | $54,790 | 1.230 Y | 0.637 | ||||||
| 10-year | $55,607 | 1.245 Y | 0.644 |
Notes:
Incremental pemetrexed maintenance to BSC;
data based upon the evidence submission from the manufacturer (Eli Lilly) to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal process.
Abbreviations: AE, adverse events; BSA, body surface area; BSC, best supportive care; D, days; ERG, evidence review group; ICER, incremental cost-effectiveness ratio; JPY, Japanese Yen; LYG, life-year gained; M, months; ND, not described; NSCLC, non-small cell lung cancer; OS, overall survival; PEM, pemetrexed; QALY, quality-adjusted life-year; RCT, randomized controlled trial; SQ, squamous cell carcinoma; Y, years.