Overview of Economic Analysis of Le Chevalier Vinorelbine Study

ABSTRACT: The costs and relative cost-effectiveness of different treatments for common illnesses are an increasing concern. New treatments for advanced non-small-cell lung cancer are having an impact. However, these treatments vary markedly in their direct financial costs, toxicity, and quality-of-life profiles. Direct comparisons between most combination regimens are not yet completed. Vinorelbine (Navelbine) is the first new agent approved in the United States for the treatment of metastatic non-small-cell lung cancer in more than a decade. We previously reported results of a post-hoc economic analysis that compared the anticipated cost-effectiveness of three regimens used to treat non-small-cell lung cancer (vinorelbine alone versus vinorelbine plus cisplatin [Platinol] versus vindesine plus cisplatin, the assumed standard treatment in Europe). Results showed that vinorelbine plus cisplatin was the most effective regimen. Using vinorelbine alone as a baseline, vinorelbine plus cisplatin added 56 days of life at an additional cost of $2,700, resulting in a cost-effectiveness ratio of $17,700 per year of life gained. Similarly, vindesine plus cisplatin added 19 days of life at a cost of $1,150, or $22,100 per year of life gained. Compared to vindesine plus cisplatin, vinorelbine plus cisplatin added 37 days of life at a cost of $1,570, or $15,500 per year of life gained. We conclude that the incremental cost-effectiveness of the vinorelbine plus cisplatin regimen was less than most commonly accepted medical interventions. If vinorelbine is preferred because of its favorable toxicity profile, the additional effectiveness of cisplatin added substantial efficacy at an acceptable cost.[ONCOLOGY(Suppl 4):14-17, 1998]

The failure to contain health care costs and curtail their growth is a problem common to all nations and a continuing focus of public policy debate. Attempts to control costs cannot be left to administrators and public health officials. As Eisenberg has stated, “to suggest that medical decision making can be divorced from consideration of cost denigrates the complexity of patient care.”[1] The application of economic principles to medicine does not necessarily mean that less money should or will be spent in total or for a specific condition, but rather, that these resources will be used more efficiently. Oncology services have been a particular focus of attention regarding medical costs. Oncologic costs of care for Medicare patients grew by approximately 17% annually in the late 1980s. Current estimates are that costs for oncologic care account for about 15% to 20% of the health care dollar in the United States. The several reasons for this growth include:

• Demographic changes

• A common reluctance to stop “active” therapy

• Increasing attention to quality-of-life concerns

• Innovations in biotechnology (ie, potentially effective new therapies)

• There is rarely one optimal treatment for an individual’s cancer.

The use of chemotherapy for metastatic non-small-cell lung cancer (NSCLC) is controversial. A common perception has been that chemotherapy has little impact on long-term survival. Two meta-analyses of published clinical trials, however, found a 27% to 34% reduction in risk of early death with treatment at 6 months.[2,3] In addition, recent practice guidelines from the American Society of Clinical Oncology state that “chemotherapy, ideally a platinum-based regimen, is appropriate for selected patients who have a good performance status with both unresectable, locally advanced, and metastatic NSCLC.”[4] Whether the use of chemotherapy has a beneficial effect on disease costs and is “cost-effective” is uncertain. A common perception is that chemotherapy is a poor use of societal resources.

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