Authors: Bojke, Laura¹; Sculpher, Mark¹; Stephens, Richard²; Qian, Wendi²; Thatcher, Nick³; Girling, David²

Source: PharmacoEconomics, Volume 24, Number 5, 2006 , pp. 443-452(10)

Publisher: Adis International

Abstract:

Background: The use of granulocyte colony-stimulating factor (G-CSF) can enable dose intensification of chemotherapy in small-cell lung cancer (SCLC). However, given its acquisition cost, it is important to assess its cost effectiveness within a resource-constrained health service.

Objective: To assess the cost effectiveness, from the UK NHS perspective, of G-CSF given in addition to doxorubicin, cyclophosphamide and etoposide (ACE) versus ACE alone in the management of SCLC.

Methods: Using data from a UK Medical Research Council trial (LU19) to assess chemotherapy dose intensification in patients with previously untreated SCLC of any disease extent, a retrospective cost-effectiveness analysis was undertaken. Resource use data, including hospitalisations and non-protocol cancer treatments, were collected during the first 6-month treatment phase of the trial. Mean costs (£, 2003 values) of managing patients in the two arms of the trial were calculated. Mean survival duration was calculated for the two groups using patient-specific follow-up data collected in the trial. Incremental cost-effectiveness analysis was undertaken, and uncertainty in cost effectiveness was expressed using cost-effectiveness acceptability curves.

Results: The use of G-CSF in addition to ACE chemotherapy is more costly (£4647) but results in longer mean survival duration (0.20 years; 0.18 years when discounted). This generates an incremental cost per additional life-year of £25 816 for ACE + G-CSF therapy. The probability of the addition of G-CSF being cost effective, if decision makers are willing to pay £30 000 for an additional life-year, is 0.57. Secondary analysis suggests that cost effectiveness is likely to be sensitive to assumptions about the health-related quality of life (HR-QOL) experienced by patients.

Conclusion: Based on data collected in the LU19 trial, chemotherapy dose intensification using G-CSF in SCLC adds to health service costs but increases survival duration. Its overall cost effectiveness is likely to be finely balanced.

Keywords: Cost effectiveness; Cyclophosphamide; Doxorubicin; Etoposide; Granulocyte colony stimulating factors; Neutropenia; Small cell lung cancer

Document Type: Research article

Affiliations: 1: 1 Centre for Health Economics, University of York, York, England 2: 2 Cancer Division, MRC Clinical Trials Unit, London, England 3: 3 Department of Medical Oncology, Christie Hospital NHS Trust, Manchester, England

Publication date: 2006-01-01

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