C. Copleymerriman et al., ECONOMIC VALUE OF GEMCITABINE COMPARED TO CISPLATIN AND ETOPOSIDE IN NON-SMALL-CELL LUNG-CANCER, Lung cancer, 14(1), 1996, pp. 45-61
Although chemotherapy costs have not been highlighted traditionally, t
here is increasing pressure to demonstrate the value of new treatments
within the health care budget. Pharmaceutical companies are assessing
the economic value of their products before launch. Gem-citabine is a
nucleoside analogue developed for use in solid tumours. The purpose o
f this model was to investigate the clinical outcomes and potential co
st savings for gemcitabine used as monotherapy compared to cisplatin a
nd etoposide combination therapy in late stage nonsmall cell lung canc
er (NSCLC), in a palliative (as opposed to aggressive) chemotherapy se
tting. Gemcitabine treatment data were taken from a large NSCLC study
and data from retrospective chart reviews identified through the Natio
nal Oncology Data Base. The model population and effectiveness of the
two regimens were judged to be similar, except for baseline performanc
e status. If drug costs were not included, the probability distributio
n resulting from the simulation showed median cost savings per cycle r
anging from $US 1504 to $US 7425, with a medium value of $US 2154. The
model suggested that gemcitabine would result in cost savings per cyc
le more than 90% of the time. Outpatient versus inpatient drug adminis
trations accounted for the majority of potential cost savings. Most of
the remaining cost savings were attributable to the difference in feb
rile neutropenia and antiemetic use. This economic model showed susbst
antial savings if gemcitabine was used instead of cisplatin and etopos
ide combination therapy in the United States' community care setting.
Some savings would be realized even if the location of treatment for b
oth regimens was mostly outpatient. Assessment of the product's econom
ic value before launch has assisted in our understanding of the potent
ial areas of cost savings for gemcitabine and has guided us in the des
ign of prospective randomized studies which included pharmacoeconomic
endpoints.