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Cost-effectiveness of hypothetical new cancer drugs in patients with advanced small-cell lung cancer: results of a markov chain model
Authors Carin A Uyl-de Groot, Joseph McDonnell, Guul ten Velde, David Radice, Harry J M Groen
Published 15 September 2006 Volume 2006:2(3) Pages 317—323
Carin A Uyl-de Groot1, Joseph McDonnell1, Guul ten Velde2, David Radice3, Harry J M Groen4
1Institute for Medical Technology Assessment, Erasmus Medical Center/Erasmus University, Rotterdam, The Netherlands; 2University Hospital Maastricht, Maastricht, The Netherlands; 3Pharmacia Corporation, Milan, Italy; 4University Hospital Groningen, Groningen, The Netherlands
Background: In the last decade, a number of new treatment modalities have been developed for patients with small cell lung cancer (SCLC). The clinical effects are encouraging, but little is known about the costs and cost-effectiveness of new drugs.
Methods: A Markov chain model has been developed to project patient outcomes and costs for patients with advanced SCLC. All patients in the control group were treated with etoposide– cisplatin chemotherapy. Patients in the study group received a hypothetical new drug. The model consisted of four states: response, stable disease, progressive disease, and death. Estimates of transition probabilities were calculated using published data on survival and recurrence-free survival. For the cost analysis and utility calculation, published data and expert opinion were used as sources. The duration of the follow-up was maximal 2 years.
Results: The total treatment costs in the etoposide–cisplatin group amounted to €16 038 and in the alternative treatment groups between €16 644 and €18 171. The number of life years and quality adjusted life years (QALYs) gained were very small, around 16 days. The cost effectiveness ratio varied between €22 208 and €81 443 and the cost–utility ratio varied accordingly. Results of the sensitivity analysis showed that the results were robust in favor of etoposide–cisplatin treatment.
Conclusion: SCLC is an illness with a poor prognosis which needed substantial healthcare resources to optimise patient survival and overall quality of life. New treatment modalities with better outcome and favourable cost-effective profiles can hopefully be developed.
Keywords: small cell lung cancer, costs, cost-effectiveness, modeling