Raltitrexed plus cisplatin is cost-effective compared with pemetrexed plus
cisplatin in patients with malignant pleural mesothelioma.
Author(s): Woods B, Paracha N, Scott DA, Thatcher N.
Affiliation(s): Oxford Outcomes, Oxford, UK. beth.woods@oxfordoutcomes.com
Publication date & source: 2012, Lung Cancer. , 75(2):261-7
INTRODUCTION: The National Institute for Health and Clinical Excellence (NICE)
has previously recommended pemetrexed plus cisplatin for the treatment of
patients with advanced malignant pleural mesothelioma (MPM) and WHO performance
status 0-1. Subsequent to this appraisal, randomised controlled trial (RCT) data
for raltitrexed plus cisplatin and comparing chemotherapy to active symptom
control (ASC) has become available, allowing a more complete analysis of the
comparative efficacy and cost-effectiveness of first-line chemotherapy in MPM.
METHODS: An adjusted indirect comparison is used to estimate the relative
efficacy of raltitrexed plus cisplatin and pemetrexed plus cisplatin. A
cost-effectiveness model is used to assess the lifetime costs and health outcomes
associated with these comparators and ASC. Patient level data from the EORTC
08983 trial are used to estimate baseline progression and survival rates.
Relative treatment effects are taken from RCTs; cost and utility data from the
literature.
RESULTS: Raltitrexed plus cisplatin and pemetrexed plus cisplatin were not found
to be statistically significantly different with respect to overall response,
progression free survival or overall survival. The cost-effectiveness analysis
found raltitrexed plus cisplatin to be cost-effective at a cost per quality
adjusted life year of £13,454 compared to cisplatin and £27,360 compared to ASC.
Pemetrexed plus cisplatin is dominated by raltitrexed plus cisplatin as the
raltitrexed combination offers marginally higher quality adjusted life years
(QALYs) and life years (LYs) at a substantially lower total cost.
CONCLUSION: Raltitrexed plus cisplatin is a cost-effective first-line treatment
for MPM. This conclusion was maintained across a number of sensitivity analyses.
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