Cost-effectiveness of vinorelbine alone or vinorelbine plus cisplatin for stage IV NSCLC

Le Chevalier and colleagues have reported results of a randomized controlled clinical trial comparing vinorelbine alone, versus vinorelbine combined with cisplatin, versus standard treatment consisting of vindesine and cisplatin in the treatment of patients with advanced non-small-cell lung cancer (NSCLC). Data on survival in the three study arms and estimates of the resources used to treat these patients were extracted from the publication and inserted into Statistics Canada's POpulation HEalth Model (POHEM). This model includes data on diagnostic methods, treatment, and outcomes appropriate for stage at presentation, health care utilization, and direct care costs ($ Canadian) for best supportive care and for several "standard" chemotherapy regimens used to treat advanced NSCLC. POHEM was then used to model the cost of care per patient and the total burden of cost on the Canadian health care system for each of the chemotherapy treatment strategies and for best supportive care. Based on the published survival curves for each of the vinorelbine regimens, it was possible to estimate the survival gain relative to the standard chemotherapy regimens and to best supportive care, and to estimate their cost-effectiveness as cost per life year gained. Based on this analysis, the most cost-effective standard regimen relative to best supportive care was vinblastine/cisplatin, as it increased average survival while reducing costs by $2,846 per case. Vinorelbine/cisplatin increased survival to a greater degree, but inpatient administration costs associated with the delivery of cisplatin increased treatment costs by $2,983 per case and resulted in a cost-effectiveness ratio of $6,386 per life year gained. As high-dose cisplatin is not routinely administered in the inpatient setting in Canadian institutions, estimates were made of the cost of outpatient administration. The cost of outpatient care was $55 less per case demonstrating that this is the most cost-effective way to administer the regimen. Relative to etoposide/cisplatin and vinblastine/cisplatin, outpatient vinorelbine/cisplatin proved to be cost-effective. Various chemotherapy regimens used in the management of advanced NSCLC all fall within the boundaries of cost-effectiveness generally accepted for health care interventions in Canada. Therefore, cost and cost-effectiveness should not be barriers to the utilization of vinorelbine/cisplatin in Canada.