Economic Analysis of Vinorelbine Plus Cisplatin Versus Paclitaxel Plus Carboplatin for Advanced Non-Small-Cell Lung Cancer

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Abstract
Background: It is increasingly important to have timely information about the economic impact of new cancer therapies in today's cost-conscious environment. Nearly 170 000 people are diagnosed with lung cancer annually in the United States. We performed an economic analysis alongside Southwest Oncology Group Trial S9509 to estimate the cost-effectiveness of cisplatin plus vinorelbine versus carboplatin plus paclitaxel for patients with advanced non-small-cell lung cancer. There were no statistically significant differences in survival or cancer-related quality of life between the treatment arms. Methods: Use of both protocol and nonprotocol lung cancer-related health care was tracked for 24 months from the initiation of therapy. To determine expenditures, nationally standardized costs were applied to each type of health care service used, and these were summed over time. Lifetime expenditures and 95% confidence intervals (CIs) for each arm of the trial were calculated with the use of a multivariate regression technique that accounts for censoring. Student's t tests were used to compare the difference in costs between the arms. All statistical tests were two-sided. Results: Cancer-related health care costs over the period of observation averaged $40 292 (95% CI = $36 226 to $44 359) for patients in the cisplatin plus vinorelbine arm versus $48 940 (95% CI = $44 674 to $53 208) for patients in the carboplatin plus paclitaxel arm (P = .004), with a mean difference of $8648 (95% CI = $2634 to $14 662). Protocol chemotherapy drugs and medical procedures costs were statistically significantly higher in the paclitaxel arm (P = .0003 and P<.0001, respectively), whereas protocol chemotherapy delivery costs were statistically significantly higher in the vinorelbine arm (P<.0001). There was no difference between the arms in costs for blood products, supportive care medications, nonprotocol-related inpatient or outpatient care, and nonprotocol chemotherapy. Conclusions: Treatment with carboplatin plus paclitaxel is substantially and statistically significantly more expensive than treatment with cisplatin plus vinorelbine. The majority of the cost difference is due to the additional cost of the protocol chemotherapy (approximately $12 000). Notable differences in costs of downstream health care were not apparent.