Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland.
Value Health. 2012 Jan;15(1):65-71. doi: 10.1016/j.jval.2011.08.1737. Epub 2011 Oct 22.
A recent randomized study showed switch maintenance with pemetrexed after nonpemetrexed-containing first-line chemotherapy in patients with advanced nonsmall-cell lung cancer to prolong overall survival by 2.8 months. We examined the cost-effectiveness of pemetrexed in this indication, from the perspective of the Swiss health care system, and assessed the influence of the costs of best supportive care (BSC) on overall cost-effectiveness.
A Markov model was constructed based on the pemetrexed maintenance study, and the incremental cost-effectiveness ratio (ICER) of adding pemetrexed until disease progression was calculated as cost per quality-adjusted life-year gained. Uncertainties concerning the costs of BSC on the ICER were addressed.
The base case ICER for maintenance therapy with pemetrexed plus BSC compared to BSC alone was €106,202 per quality-adjusted life-year gained. Varying the costs for BSC had a marked effect. Assuming a reduction of the costs for BSC by 25% in the pemetrexed arm resulted in an ICER of €47,531 per quality-adjusted life-year, which is below predefined criteria for cost effectiveness in Switzerland.
Switch maintenance with pemetrexed in patients with advanced nonsquamous-cell lung cancer after standard first-line chemotherapy is not cost-effective. Uncertainties on the resource use and costs for BSC have a large influence on the cost-effectiveness calculation and should be reported in more detail.
最近一项随机研究表明，在晚期非小细胞肺癌患者中，在一线化疗不包含培美曲塞的情况下进行培美曲塞维持治疗，可以将总生存期延长 2.8 个月。我们从瑞士医疗保健系统的角度检查了培美曲塞在这一适应证中的成本效益，并评估了最佳支持治疗（BSC）成本对总体成本效益的影响。
基于培美曲塞维持治疗研究构建了一个 Markov 模型，并计算了添加培美曲塞直至疾病进展的增量成本效益比（ICER），即每获得一个质量调整生命年的成本。解决了 BSC 成本对 ICER 的不确定性。
培美曲塞联合 BSC 维持治疗与单独 BSC 相比的基础病例 ICER 为每质量调整生命年 106202 欧元。BSC 的成本变化对 ICER 有显著影响。假设培美曲塞组 BSC 成本降低 25%，则 ICER 为每质量调整生命年 47531 欧元，低于瑞士成本效益的预设标准。
在标准一线化疗后，晚期非鳞状细胞肺癌患者使用培美曲塞进行转换维持治疗在成本效益方面并不合理。BSC 的资源使用和成本的不确定性对成本效益计算有很大影响，应更详细地报告。
