ECONOMIC VALUE OF GEMCITABINE COMPARED TO CISPLATIN AND ETOPOSIDE IN NON-SMALL-CELL LUNG-CANCER

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.