OBJECTIVES: The majority of patients with non-small cell lung cancer (NSCLC) present with advanced disease, for which pharmacological therapy is the primary treatment option. Economic models are useful tools to help decision-makers determine the cost and health impact of existing and new therapies in their practice settings.
METHODS: A decision-analytic model was developed to represent the progression of advanced (stage IIIB/IV) NSCLC from diagnosis and first-line therapy to subsequent lines of therapy, best supportive care and death. The model is a semi-Markov process with three-week cycles and a two-year time horizon. By selecting different sets of model parameters, it may be used to estimate costof- illness (by pooling cost and health outcomes across a range of therapies), cost-effectiveness (comparison between new or existing therapeutic options) and impact on health-care budgets. Data sources include published clinical trials, treatment patterns based on published studies, and a panel of US clinicians and US unit costs. In this case, the NSCLC model was used to examine the costs and outcomes of a distribution of mono and combination agents most commonly administered as first and secondline therapy in the US.
RESULTS: Over one and two years respectively the average cost of therapy was $42,319 and $48,151 per patient, with an estimated survival of 40.2% and 7.4%. The estimated cost for a health-care purchaser with a prevalence of 100 patients with advanced NSCLC was $4.90 million per year. If all patients used carboplatin and paclitaxel as first-line therapy, this increased to $5.14 million. If a new therapy increased the median time to progression for patients on first-line therapy by two months, the cost increased to $5.0 million per year.
CONCLUSION: This model provides a flexible analytical platform for a range of economic evaluations of alternative therapeutic strategies in advanced NSCLC. This is valuable for strategic planning in Phase II/III drug development.
