Cost effectiveness of increasing the dose intensity of chemotherapy with granulocyte colony-stimulating factor in small-cell lung cancer: based on data from the Medical Research Council LU19 trial.

2.50
Hdl Handle:
http://hdl.handle.net/10541/72515
Title:
Cost effectiveness of increasing the dose intensity of chemotherapy with granulocyte colony-stimulating factor in small-cell lung cancer: based on data from the Medical Research Council LU19 trial.
Authors:
Bojke, Laura; Sculpher, Mark; Stephens, Richard J; Qian, Wendi; Thatcher, Nick; Girling, David J
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 ( pound, 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 pounds) 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 pounds 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 pounds 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.
Affiliation:
Centre for Health Economics, University of York, York, England. lg116@york.ac.uk
Citation:
Cost effectiveness of increasing the dose intensity of chemotherapy with granulocyte colony-stimulating factor in small-cell lung cancer: based on data from the Medical Research Council LU19 trial. 2006, 24 (5):443-52 Pharmacoeconomics
Journal:
Pharmacoeconomics
Issue Date:
2006
URI:
http://hdl.handle.net/10541/72515
PubMed ID:
16706570
Type:
Article
Language:
en
ISSN:
1170-7690
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorBojke, Laura-
dc.contributor.authorSculpher, Mark-
dc.contributor.authorStephens, Richard J-
dc.contributor.authorQian, Wendi-
dc.contributor.authorThatcher, Nick-
dc.contributor.authorGirling, David J-
dc.date.accessioned2009-07-06T08:34:01Z-
dc.date.available2009-07-06T08:34:01Z-
dc.date.issued2006-
dc.identifier.citationCost effectiveness of increasing the dose intensity of chemotherapy with granulocyte colony-stimulating factor in small-cell lung cancer: based on data from the Medical Research Council LU19 trial. 2006, 24 (5):443-52 Pharmacoeconomicsen
dc.identifier.issn1170-7690-
dc.identifier.pmid16706570-
dc.identifier.urihttp://hdl.handle.net/10541/72515-
dc.description.abstractBACKGROUND: 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 ( pound, 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 pounds) 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 pounds 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 pounds 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.en
dc.language.isoenen
dc.subjectLung Canceren
dc.subject.meshAntineoplastic Combined Chemotherapy Protocols-
dc.subject.meshCarcinoma, Small Cell-
dc.subject.meshCost-Benefit Analysis-
dc.subject.meshCyclophosphamide-
dc.subject.meshDose-Response Relationship, Drug-
dc.subject.meshDoxorubicin-
dc.subject.meshEtoposide-
dc.subject.meshGranulocyte Colony-Stimulating Factor-
dc.subject.meshHumans-
dc.subject.meshLung Neoplasms-
dc.subject.meshMiddle Aged-
dc.subject.meshQuality-Adjusted Life Years-
dc.subject.meshRandomized Controlled Trials as Topic-
dc.subject.meshRetrospective Studies-
dc.subject.meshState Medicine-
dc.subject.meshSurvival Analysis-
dc.titleCost effectiveness of increasing the dose intensity of chemotherapy with granulocyte colony-stimulating factor in small-cell lung cancer: based on data from the Medical Research Council LU19 trial.en
dc.typeArticleen
dc.contributor.departmentCentre for Health Economics, University of York, York, England. lg116@york.ac.uken
dc.identifier.journalPharmacoeconomicsen
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