Cost-effectiveness analysis of pemetrexed + cisplatin versus paclitaxel + carboplatin versus paclitaxel + carboplatin + bevacizumab in patients with advanced non-small cell lung cancer without previous treatment

Abstract

Introduction: According to the International Agency for Research on Cancer (Iarc/WHO), lung cancer is one of the most prevalent neoplasms worldwide. In Brazil, National Cancer Institute (INCA) estimated that in 2010 27,630 new cases of lung cancer would happen, making this the fourth highest incidence of cancer in the country. Related to the number of deaths, cancer is responsible for higher mortality, with 20,485 deaths due to lung cancer in 2008 in Brazil. Objective: To develop a cost-effectiveness analysis comparing the first-line treatment with pemetrexed + cisplatin (PC) with carboplatin + paclitaxel (CP) and bevacizumab + carboplatin + paclitaxel (BCP) in patients with advanced non-small cell lung cancer (NSCLC), under private health care system perspective. Methods: A Markov model was developed to compare the three treatment alternatives for patients with NSCLC. The outcomes used were progression-free survival (PFS) and overall survival (OS), for the time horizon of three years. Epidemiological data and efficacy data were obtained from literature review. Cost data were obtained from CMED price list to drugs, Revista Simpro to materials and CBHPM to tests and procedures. The results were expressed as incremental cost-effectiveness ratio (ICER) per life year saved and progression free life years. Probabilistic sensitivity analysis was performed on the main parameters of the model. Results: Compared to BCP, the PC reduces cost and increases the OS at 0.05 years, being the dominant treatment alternative. Compared to CP, the PC increases the OS at 0.15 years and the PFS at 0.10 years, being more effective and cheaper. Conclusion: This model suggests that PC is the drug more effective in first-line treatment of patients with NSCLC in Brazil. PC is dominant in terms of OS compared to BCP, and is dominant in terms of OS and PFS compared to CP.