Journal article
A cost-effectiveness analysis of consolidative local therapy in oligometastatic non-squamous non-small cell lung cancer (NSCLC).
- Panje CM Department of Radiation Oncology, Cantonal Hospital St. Gallen, Switzerland. Electronic address: cedric.panje@kssg.ch.
- Dedes KJ Department of Gynecology, University Hospital Zurich, Switzerland.
- Matter-Walstra K Swiss Group for Clinical Cancer Research Coordinating Centre, Bern, Switzerland; Institute of Pharmaceutical Medicine, University of Basel, Switzerland.
- Schwenkglenks M Institute of Pharmaceutical Medicine, University of Basel, Switzerland.
- Gautschi O Medical Oncology, Department of Internal Medicine, Cantonal Hospital Lucerne, Switzerland.
- Siano M Department of Medical Oncology, Cantonal Hospital St. Gallen, Switzerland.
- Aebersold DM Department of Radiation Oncology, University of Bern, Switzerland.
- Plasswilm L Department of Radiation Oncology, Cantonal Hospital St. Gallen, Switzerland; Department of Radiation Oncology, University of Bern, Switzerland.
- Lupatsch JE Swiss Group for Clinical Cancer Research Coordinating Centre, Bern, Switzerland; Institute of Pharmaceutical Medicine, University of Basel, Switzerland.
- 2018-08-15
Published in:
- Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. - 2018
Cost-effectiveness
Incremental cost-effectiveness ratio
Lung cancer
Oligometastatic
Quality-adjusted life year
Antineoplastic Agents
Carcinoma, Non-Small-Cell Lung
Catheter Ablation
Chemoradiotherapy
Combined Modality Therapy
Cost-Benefit Analysis
Humans
Lung Neoplasms
Maintenance Chemotherapy
Markov Chains
Pemetrexed
Prognosis
Protein Kinase Inhibitors
Protein-Tyrosine Kinases
Quality-Adjusted Life Years
Radiation Dose Hypofractionation
English
BACKGROUND
Novel systemic therapies have improved the prognosis of metastatic non-small cell lung cancer (NSCLC), but costs of some of these drugs are a matter of ongoing debate. More recently, local therapies (LT) such as radiotherapy and surgery have been suggested as additional treatment in oligometastatic NSCLC demonstrating an improved progression-free survival (PFS) in a phase II trial compared to maintenance chemotherapy (MC) alone. The aim of this analysis was to assess the cost-effectiveness of local therapies in oligometastatic NSCLC.
METHODS
We constructed a Markov model comparing the cost-effectiveness of LT versus MC for oligometastatic NSCLC from the Swiss healthcare payer's perspective. Treatment specifications and PFS were based on the phase II trial (NCT01725165). Overall survival (OS) was inferred from a recent phase III trial. Utilities were taken from published data. Primary outcome was the incremental cost-effectiveness-ratio (ICER, costs in Swiss Francs (CHF) per quality-adjusted life-year (QALY) gained).
RESULTS
PFS in the model was 3.8 months for MC and 11.4 months for LT (compared to 3.9 months and 11.9 months in the trial). OS in the model was 15.5 months in both arms. LT was cost-effective with a gain of 0.24 QALYs at an additional cost of CHF 9641, resulting in an ICER of CHF 40,972/QALY gained. Probabilistic sensitivity analyses demonstrated that LT was dominant or cost-effective at a willingness-to-pay threshold of CHF 100,000 per QALY in 61.7% of the simulations.
CONCLUSIONS
LT may be cost-effective for selected patients with oligometastatic NSCLC responding to first-line systemic therapy.
Novel systemic therapies have improved the prognosis of metastatic non-small cell lung cancer (NSCLC), but costs of some of these drugs are a matter of ongoing debate. More recently, local therapies (LT) such as radiotherapy and surgery have been suggested as additional treatment in oligometastatic NSCLC demonstrating an improved progression-free survival (PFS) in a phase II trial compared to maintenance chemotherapy (MC) alone. The aim of this analysis was to assess the cost-effectiveness of local therapies in oligometastatic NSCLC.
METHODS
We constructed a Markov model comparing the cost-effectiveness of LT versus MC for oligometastatic NSCLC from the Swiss healthcare payer's perspective. Treatment specifications and PFS were based on the phase II trial (NCT01725165). Overall survival (OS) was inferred from a recent phase III trial. Utilities were taken from published data. Primary outcome was the incremental cost-effectiveness-ratio (ICER, costs in Swiss Francs (CHF) per quality-adjusted life-year (QALY) gained).
RESULTS
PFS in the model was 3.8 months for MC and 11.4 months for LT (compared to 3.9 months and 11.9 months in the trial). OS in the model was 15.5 months in both arms. LT was cost-effective with a gain of 0.24 QALYs at an additional cost of CHF 9641, resulting in an ICER of CHF 40,972/QALY gained. Probabilistic sensitivity analyses demonstrated that LT was dominant or cost-effective at a willingness-to-pay threshold of CHF 100,000 per QALY in 61.7% of the simulations.
CONCLUSIONS
LT may be cost-effective for selected patients with oligometastatic NSCLC responding to first-line systemic therapy.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.radonc.2018.07.017
- PMID 30104008
- Persistent URL
- https://roar.hep-bejune.ch/global/documents/184855
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