Cost-Effectiveness of Second-Line Chemotherapy for Non-small Cell Lung Cancer: An Economic, Randomized, Prospective, Multicenter Phase III Trial Comparing Docetaxel and Pemetrexed: The GFPC 05-06 Study

Abstract

Second-line treatment for NSCLC is more cost-effective with docetaxel than with pemetrexed. Both strategies have acceptable cost-effectiveness ratios compared with commonly used and reimbursed regimens for advanced NSCLC.

Efficacy of First-line Chemotherapy Affects the Second-Line Setting Response in Patients with Advanced Non-Small Cell Lung Cancer

“…A multivariate Cox-regression model was used to analyze prognostic factors for PFS and OS, presenting a hazard ratio (HR) and confidence interval (CI) for the independent variables. Statistical analyses were performed using SPSS 17.0, and a p-value less than 0.05 was considered statistically significant (Vergnenegre et al, 2011).…”

Cost-effectiveness of three strategies for second-line erlotinib initiation in nonsmall-cell lung cancer: the ERMETIC study part 3

“…The characteristics of the patients treated with docetaxel were the following: median age was 59 yrs, 15% of patients were female, 93% of patients had a PFS of 0 or 1, 9% had never smoked and 74% had adenocarcinoma. The EGFR status of these patients was unknown [20].…”

“…In the biologically guided strategy, patients with known EGFR mutations were assumed to receive erlotinib, while patients with no EGFR mutations or unknown status were assumed to receive docetaxel. Docetaxel was chosen as the alternative to erlotinib as it is routinely used for second-line NSCLC therapy [3] and is more cost-effective than pemetrexed [20,21]. It was assumed that Clinically oriented docetaxel has the same efficacy in a clinically selected population as in an EGFR wild-type population [17].…”

“…Clinical inputs were derived from individual patient data in the ERMETIC study [8] and the GFPC0506 study (table 1) [20]. ERMETIC [8] was a prospective observational multicentre cohort involving 522 consecutive patients with advanced NSCLC treated with second-line erlotinib between March 2007 and April 2008 at 16 French centres.…”

“…We conducted an indirect comparison of the cost-utility of EGFR mutation screening, based on data from two prospective studies, namely the ERMETIC prospective multicentre cohort [8] and a prospective, randomised multicentre trial (the GFPC0506 study) comparing docetaxel and pemetrexed in the second-line setting [20]. The objective was to compare, using a Markov model, the costeffectiveness ratios (CERs) of three hypothetical strategies for second-line erlotinib initiation for NSCLC: initiation with no patient selection, clinically guided initiation (nonsmoker females with adenocarcinoma receiving erlotinib; other patients receiving docetaxel) and initiation based on EGFR mutation status (erlotinib for EGFR-mutated patients and docetaxel for all other patients).…”