Is Pemetrexed/Platinum Therapy Cost-Effective in NSCLC?

Audrey Andrews

July 2012, Vol 3, No 5 - AMCP Annual Meeting

San Francisco, CA—In what appears to be the first study to use real-world, non–clinical trial data to evaluate the cost-effectiveness of pemetrexed/platinum (Pem/P) therapy used first line in patients with advanced non–smallcell lung cancer (NSCLC), this combination trended toward being more effective and less costly than carboplatin/ paclitaxel plus bevacizumab (C/Pa+B), reported Manan Shah, PharmD, PhD, with Xcenda, Palm Harbor, FL, and colleagues at the 2012 Academy of Managed Care Pharmacy annual meeting.

In a second comparison, Pem/P was costlier than C/Pa alone (without bevacizumab), but had a potential incremental clinical benefit, according to this study.

“Therefore, depending on society’s or payers’ willingness to pay, Pem/P may be seen as more cost-effective compared to C/Pa due to the fact that Pem/P demonstrated effectiveness at a higher cost,” Dr Shah and colleagues noted.

Recent phase 3 trials have shown the effectiveness of certain doublet and triplet first-line combination therapies, such as Pem/P, C/Pa, and C/Pa+B, in advanced nonsquamous NSCLC, but the cost-effectiveness of these regimens has not been documented. This retrospective analysis compared the real-world incremental cost-effectiveness of the 3 regimens based on data from the International Oncology Network database, which represents 20 large US community oncology practices. The study included data from 2006 to 2010; the index date was when first-line treatment was initiated. Patients were followed for 12 months to assess progression, death, and associated cost of care.

Comparator patient cohorts receiving first-line C/Pa or C/Pa+B were matched to patients in the Pem/P cohort based on index year, stage at diagnosis, sex, performance status, and age.

total of 900 patients included 300 in the Pem/P cohort (carboplatin, N = 222; cisplatin, N = 78) and 300 matched pairs in each of the other 2 treatment cohorts.

Improved PFS, Lower Costs with Pem/P versus C/Pa+B

Patients receiving Pem/P had a significant median progression-free survival (PFS) benefit (134 days) compared with patients receiving C/Pa+B (126 days), with a first event occurring in 86% versus 94% of patients, respectively (hazard ratio [HR], 0.68; P <.001). Overall survival (OS) was higher, although not significantly different, with Pem/P (298 days) than with C/Pa+B (271 days).

Patients receiving Pem/P had significantly lower mean costs compared with patients receiving C/Pa+B. Mean PFS costs were $33,745 with Pem/P and $48,905 with C/Pa+B, for a difference of $15,160. Overall costs were $33,969 with Pem/P versus $53,915 with C/Pa+B, for a $19,946 difference.

The probability that Pem/P was more effective and less costly than C/Pa+B was 69.5% for PFS and 85% for OS.

Pem/P versus C/Pa

Similarly, patients receiving Pem/P had longer PFS (134 days) than those receiving C/Pa (106 days), but also higher costs. The mean PFS costs were $21,841 higher with Pem/P compared with C/Pa, and the overall cost was $19,137 with the former compared with the latter. “Pem/P had a higher probability of being more costly but more effective than C/Pa,” Dr Shah and colleagues noted.

OS was 298 days with Pem/P versus 218 days with C/Pa, with events occurring in 66% versus 74% of patients, respectively (HR, 0.88; P = .08).

Based on PFS, OS, and cost results, although Pem/P was more costly than C/Pa, it nevertheless had a potential cost-effective benefit.

The analyses did not evaluate the entire continuum of care in terms of cost, the investigators said.