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Published online before print February 15, 2006
Eur Respir J 2006, doi:10.1183/09031936.06.00102705
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ORIGINAL ARTICLE

Cost-utility analysis of chemotherapy in symptomatic advanced non-small cell lung cancer

C.A. Dooms 1*, Y.N. Lievens 2, J.F. Vansteenkiste 1

1 Respiratory Oncology Unit (Pulmonology) and Leuven Lung Cancer Group, Catholic University, Leuven, Belgium
2 Dept of Radiation Oncology and Leuven Lung Cancer Group, Catholic University, Leuven, Belgium

* To whom correspondence should be addressed. E-mail: christophe.dooms{at}uz.kuleuven.ac.be.


  Abstract

When using chemotherapy in patients with a short life expectancy, outcomes such as Symptom Improvement or Clinical Benefit receive increasing attention. Outcomes of subjective benefit to the patient can be rated as a utility in order to perform health economic analyses and comparisons with other treatment conditions. A cost-utility analysis has been performed alongside a prospective randomised clinical trial comparing single agent Gemcitabine to Cisplatin-based chemotherapy in symptomatic advanced NSCLC patients.

Global Quality-of-Life as well as resource utilisation data were collected during first line chemotherapy for both treatment arms. Incremental costs, utilities and cost-utility ratio were calculated.

Per patient, an incremental cost of 1,522 {euro} was obtained for Gemcitabine compared to Cisplatin-Vindesine, mainly as a consequence of the direct cost of the cytotoxic drugs. When combined with utility, this resulted in an incremental cost-utility ratio for Gemcitabine of 13,836 {euro} per Quality-Adjusted Life Year gained.

In conclusion, although the least expensive strategy is Cisplatin-Vindesine, the greater Clinical Benefit of Gemcitabine, leading to an acceptable incremental cost-utility ratio as compared to other health care interventions, balances its higher cost. The gains in subjective outcome achieved with palliative chemotherapy are critical from both a clinical and a health economic point of view.

Keywords:  Cisplatin-based chemotherapy, clinical benefit, cost-utility ratio, economic analysis, gemcitabine, non-small cell lung cancer




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