The first known study to use real-world, nontrial data to evaluate the cost-effectiveness of first-line combination therapies for patients with advanced nonsquamous non–small-cell lung cancer (NSCLC) was conducted by Manan Shah, PharmD, PhD, and colleagues at Xcenda, Palm Harbor, FL. The therapies included were pemetrexed/ platinum (Pem/P) relative to carboplatin/paclitaxel plus bevacizumab (C/Pa + B).
The team used an electronic medical record database of 20 large US community oncology practices to identify patients with advanced nonsquamous NSCLC who were initiated with first-line therapy with Pem/P, C/Pa + B, or with carboplatin/paclitaxel (C/Pa) between 2006 and 2009.
Using a 1:1 ratio, patients receiving C/Pa + B or C/Pa were matched with patients receiving Pem/P on key characteristics, including cancer stage at diagnosis, sex, age, and Eastern Cooperative Oncology Group performance status. Patients were followed for 1 year after treatment initiation to assess disease progression, death, and costs (ie, charges for chemotherapy, supportive care, and physician/nursing services). For each comparison, 300 matched pairs with similar baseline characteristics were identified.
Progression-free survival (PFS) costs and overall survival (OS) costs in the Pem/P group ($33,745 and $33,969, respectively) were lower than in the C/Pa + B group ($48,905 and $53,915, respectively); however, these costs were even lower in the C/Pa group ($11,904 vs $14,832, respectively).
Patients receiving Pem/P had a significant longer median PFS (134 days) compared with those receiving C/Pa + B (126 days) or C/Pa (106 days). A nonsignificant trend for longer OS was seen in the Pem/P group (298 days) versus the C/Pa + B group (271 days), as well as in the Pem/P group versus the C/Pa group (298 vs 218 days, respectively).
Overall, the use of Pem/P as first-line therapy was more cost-effective than C/Pa + B, Dr Shah and colleagues noted; therefore, despite its higher cost, this regimen may be more cost-effective than C/Pa, considering its greater effectiveness. [Shah M, Winfree KB, Peterson PM, et al. Cost-effectiveness of pemetrexed/platinum therapy for first-line advanced non-small cell lung cancer.]