Cost-Effectiveness of Pemetrexed Plus Cisplatin as First-Line Therapy for Advanced Nonsquamous Non-small Cell Lung Cancer Robert Klein, MS, Catherine.

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Cost-Effectiveness of Pemetrexed Plus Cisplatin as First-Line Therapy for Advanced Nonsquamous Non-small Cell Lung Cancer Robert Klein, MS, Catherine Muehlenbein, MPH, MBA, Astra M. Liepa, PharmD, Steve Babineaux, MS, RPh, Ron Wielage, MPH, Lee Schwartzberg, MD Journal of Thoracic Oncology Volume 4, Issue 11, Pages 1404-1414 (November 2009) DOI: 10.1097/JTO.0b013e3181ba31e0 Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Overall survival in patients with stage IIIB/IV NSCLC by histologic subtype treated with first-line cisplatin and pemetrexed (Cis/Pem) versus cisplatin/gemcitabine (Cis/Gem). Cis/Pem demonstrated noninferior efficacy compared with Cis/Gem as first-line treatment in patients with locally advanced or metastatic NSCLC. A prespecified subset analysis demonstrated statistically superior overall survival time for Cis/Pem compared with Cis/Gem in patients with adenocarcinoma or large cell histology. *Nonsquamous refers to adenocarcinoma and large cell carcinoma. CG, cisplatin/gemcitabine; CI, confidence interval; CP, cisplatin/pemetrexed; HR, hazard ratio; NSCLC, non-small cell lung cancer. Reprinted with permission. © 2008 American Society of Clinical Oncology. All rights reserved. Scagliotti GV, Parikh P, von Pawel J, et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non–small-cell lung cancer. J Clin Oncol 2008;26:3543–3551. Journal of Thoracic Oncology 2009 4, 1404-1414DOI: (10.1097/JTO.0b013e3181ba31e0) Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Tree diagram for first-line chemotherapy regimens. The cost-effectiveness model was based on four health states including complete response, partial response, stable disease, and progressive disease. Bev, bevacizumab; Carb, carboplatin; Chemo, chemotherapy; Cis, cisplatin; Gem, gemcitabine; NSCLC, non-small cell lung cancer; Pac, paclitaxel; Pem, pemetrexed. Journal of Thoracic Oncology 2009 4, 1404-1414DOI: (10.1097/JTO.0b013e3181ba31e0) Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Tree diagram for health states after completion of first-line chemotherapy regimens. The model is initiated with a cohort of patients with stage IIIB/IV NSCLC starting a prescribed course of first-line chemotherapy. After completing or discontinuing first-line chemotherapy, health states included second-line chemotherapy, stable disease without chemotherapy, progressive disease without chemotherapy, and end-of-life care. For the triplet of carboplatin/paclitaxel/bevacizumab (Carb/Pac/Bev), there was an additional bevacizumab monotherapy maintenance state. Finally, there was a death state, which can be reached from all other states. Bev, bevacizumab; Carb, carboplatin; Chemo, chemotherapy; NSCLC, non-small cell lung cancer; Pac, paclitaxel. Journal of Thoracic Oncology 2009 4, 1404-1414DOI: (10.1097/JTO.0b013e3181ba31e0) Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 Effect of select assumptions and uncertainty in cost inputs in predicting the cost-effectiveness of cisplatin and pemetrexed (Cis/Pem) compared with cisplatin/gemcitabine (Cis/Gem). This tornado diagram shows that most reasonable changes in costs that were applied to all treatments changed the incremental cost-effectiveness ratio (ICER) for Cis/Pem to Cis/Gem by less than 10%. LYG, life-year gained; NSCLC, non-small cell lung cancer; Pem, pemetrexed. Journal of Thoracic Oncology 2009 4, 1404-1414DOI: (10.1097/JTO.0b013e3181ba31e0) Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions