A Pharmacoeconomic Evaluation For The First-line Therapy Of The Advanced Non-small Cell Lung Cancer

In the current context of increasingly stretched healthcare budgets, however, efficacy and safety should not be the only criteria to guide therapeutic decisions in clinical application. The growing needs and demands of new drugs and the higher costs of new treatments have forced decision-makers to pay greater attention to how to use the limited resources in the most efficient way.In this study, we used the principle and methods of decision sciences to perform a pharmacoeconomic evaluation for different first-line therapies for the patients of advanced non-small cell lung cancer (NSCLC), including Vinorelbine/Cisplatin(NP), Gemcitabine/Cisplatin(GP), Docetaxel/Cisplatin and Docetaxel/Cisplatin(DP), to help to choose a suitable chemotherapy for the patients in clinical practice. The main contents are as follows:(1) We built the cost model based on the charging standard of Jiangsu Province Tumor Hospital to calculate the direct cost of the NP, GP, DP per treatment cycle, and we collected the clinical benefit rates of different therapies as effectiveness from published literatures. By a traditional decision analysis, we estimated the cost effectiveness of first-line therapies.(2) Based on the response evaluation criteria in solid tumors of WHO, we developed a Markov decision tree model with four health states, those were response, stable, progressive and dead. Based on the DEALE methods, the transition probabilities in Markov model were estimated from the data of the randomized clinical trials published in the core journals in China. Utility weights used in the model were assigned to each health states based on the Naffees's study. The Markov analysis was performed to simulate the numbers of people in each of states after 2 years.The main results of the study are as follows:(1) By using the traditional decision analysis. We found the rankings of the cost per cycle are the NP, DP and GP. The rankings of the clinical benefit rates are the DP, NP and GP. The rankings of the median survival time are the NP, DP and GP. Taken both the cost and effectiveness into analysis, the results of the cost-effecctiveness analysis is that the NP regimen is the most cost-effective, no matter in the short-term or long-term evaluation. The incremental cost-effectiveness analysis shows that when the NP regimen is used as reference, the DP regimen is the dominated one.(2) The Markov decision model shows that the rankings of the survival time are the GP, DP and NP, no matter which one of life months or the qualified adjusted life months is used as the effitiveness index. Therefore, the GP regimen is the dominant treatment.