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A Cost-Effectiveness Analysis of Docetaxel in the Second-Line Treatment of Non-Small Cell Lung Cancer

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Abstract

Background: Whilst lung cancer is the most common form of cancer in England and Wales (annual incidence rate of 50 per 100 000) it does not always receive the policy attention accorded to other types of cancer, such as breast and colorectal. Nevertheless, the burden of lung cancer is significant and the UK NHS Plan for cancer has set out the government’s commitment to improving all cancer services. The question faced by the NHS is which interventions are most cost effective in implementing this plan.

Objective: To develop a model to assess the economics of second-line treatment of non-small cell lung cancer (NSCLC) from the perspective of the UK NHS, based on the resources and outcomes from the pivotal clinical study comparing docetaxel 75 mg/m2 with best supportive care (BSC).

Methods: The area under the survival curve for each treatment was analysed and the difference in mean survival between the docetaxel group and the BSC group was calculated as 3.82 months. Measurable incremental costs for the docetaxel group were largely driven by drug acquisition and administration. These cost drivers, as well as toxicity treatment costs and cost offsets, were varied in the sensitivity analysis. Although the overall timeframe for the model was 2 years, discounting was not applied as the resources and benefits of docetaxel use in this setting are realised relatively immediately.

Results: The base case cost-effectiveness analysis (mean values) reported a cost per life-year gained of £13 863 for docetaxel 75 mg/m2 (year 2000/2001 values). Sensitivity analysis showed that the number of treatment cycles per patient, which affected total treatment cost, had most influence on the cost per life-year gained in the base case scenario. Using the 95% confidence intervals around the mean number of treatment cycles, the base case cost per life-year gained varied from £10 985 to £16 738. Using the 95% confidence intervals around the mean difference in survival, to represent best and worst case scenarios, the cost per life-year saved ranged from £10 020 to £32 781.

Conclusion: This model suggests, with its underlying assumptions and data, docetaxel 75 mg/m2 in 3-weekly cycles is a cost-effective second-line treatment, from the perspective of the NHS, for pretreated NSCLC in terms of survival gains made for a reasonable increase in costs.

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Acknowledgements

This study was conducted by Beaufort International Health Economics and PMSI Healthcare, London, UK, under contract to Aventis Pharma. P. Sharplin and U. Bose are employees of Aventis Pharma, Kent, UK.

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Authors and Affiliations

  1. PMSI Healthcare, London, UK

    Jeremy Holmes

  2. Glasgow Royal Infirmary, Glasgow, Scotland, UK

    David Dunlop

  3. Aventis Pharma, West Malling, Kent, England

    Lindsay Hemmett, Peter Sharplin & Uday Bose

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  1. Jeremy Holmes
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  2. David Dunlop
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  3. Lindsay Hemmett
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  4. Peter Sharplin
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  5. Uday Bose
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Correspondence to Jeremy Holmes.

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Holmes, J., Dunlop, D., Hemmett, L. et al. A Cost-Effectiveness Analysis of Docetaxel in the Second-Line Treatment of Non-Small Cell Lung Cancer. PharmacoEconomics 22, 581–589 (2004). https://doi.org/10.2165/00019053-200422090-00003

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