The cost-effectiveness of four cisplatin-containing chemotherapy regimens in the treatment of stages III B and IV non-small cell lung cancer: an Italian perspective.

The cost-effectiveness of four cisplatin-containing chemotherapy regimens used in the treatment of non-small cell lung cancer (NSCLC) stages III B and IV was retrospectively assessed specifically with respect to the situation in Italy and from the third party payer perspective. The chemotherapy regimens compared were gemcitabine+cisplatin (G + C), mitomycin+ifosfamide+cisplatin (MIP), etoposide+cisplatin (E + C), and vinorelbine+cisplatin (V + C). Efficacy and safety data for the regimens were calculated from studies selected from the international literature using formal inclusion and exclusion criteria. In total, one study with one G + C treatment arm (48 patients), one study with one MIP treatment arm (133 patients), three studies with one E + C treatment arm (total 325 patients), and two studies with one V + C treatment arm (total 327 patients) were included. Where efficacy and toxicity results for the same regimen were reported in more than one study, the values were combined using a random effects meta-analysis method. The mean tumour response rates were: 54% (95% confidence intervals (CI) 40-69%); 40% (95% CI 32-49%); 26% (95% CI 20-30%); and 35% (95% CI 24-48) for G + C, MIP, E + C and V + C, respectively. Costs were evaluated for World Health Organization (WHO) grade 3 and 4 toxicities with high impact on medical costs using computer modelling techniques. The official prices of drugs and official reimbursement rates were used to calculate direct medical costs. Average cost-effectiveness analysis demonstrated no significant difference between the treatments. Marginal cost-effectiveness analysis showed that the use of MIP, E + C or V + C instead of G + C would result in additional costs of 7.7, 55.2 (p < 0.05), and 46.2 million lira, respectively, for every patient with a tumour response.