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)
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
BMC Cancer 2012, 12:301 doi:10.1186/1471-2407-12-301Published: 20 July 2012
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).
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.
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.
In terms of cost effectiveness, in fit elderly patients with NSCLC, erlotinib followed by chemotherapy compares well with the reverse strategy.