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Open Access Research article

Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504)

Chouaid Christos19*, Le Caer Hervé2, Locher Chrystelle3, Dujon Cecile4, Thomas Pascal5, Auliac Jean Bernard6, Monnet Isabelle7, Vergnenegre Alain8 and and GFPC 0504 Team

Author Affiliations

1 AP-HP Hôpital St-Antoine, AP-HP, UMPC, Paris, France

2 CH de Draguignan, Draguignan, France

3 CH de Meaux, Meaux, France

4 CHI de Versailles, Versailles, France

5 CH de Gap, Paris, France

6 CH de Mantes La Jolie, Mantes La Jolie, France

7 CHI de Creteil, Creteil, France

8 CHU de Limoges, Limoges, France

9 Service de Pneumologie, Hôpital Saint-Antoine, 84 rue du boulevard Saint-Antoine, 75012, Paris, France

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BMC Cancer 2012, 12:301  doi:10.1186/1471-2407-12-301

Published: 20 July 2012

Abstract

Background

The median age of newly diagnosed patients with non-small cell lung cancer (NSCLC) is 67 years, and one-third of patients are older than 75 years. Elderly patients are more vulnerable to the adverse effects of chemotherapy, and targeted therapy might thus be a relevant alternative. The objective of this study was to assess the cost-effectiveness of erlotinib followed by chemotherapy after progression, compared to the reverse strategy, in fit elderly patients with advanced NSCLC participating in a prospective randomized phase 2 trial (GFPC0504).

Methods

Outcomes (PFS and overall survival) and costs (limited to direct medical costs, from the third-party payer perspective) were prospectively collected until second progression. Costs after progression and health utilities (based on disease states and grade 3–4 toxicities) were derived from the literature.

Results

Median overall survival, QALY and total costs for the erlotinib-first strategy were respectively 7.1 months, 0.51 and 27 734 €, compared to 9.4 months, 0.52 and 31 688 € for the chemotherapy-first strategy. The Monte Carlo simulation demonstrates that the two strategies do not differ statistically.

Conclusion

In terms of cost effectiveness, in fit elderly patients with NSCLC, erlotinib followed by chemotherapy compares well with the reverse strategy.

Keywords:
Cost-utility; Erlotinib; Non-small cell lung cancer; Elderly patients; Phase II trial