English, Article edition: 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 Laura Bojke; Mark Sculpher; Richard Stephens; ...

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Physical Description
  • article
Language
  • English

Edition details

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
Author
  • Laura Bojke
  • Mark Sculpher
  • Richard Stephens
  • Wendi Qian
  • Nick Thatcher
  • David Girling
Physical Description
  • article
Notes
  • 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 (Lstg , 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 (Lstg 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 Lstg 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 Lstg 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.
  • Cost-effectiveness, Cost-utility, Cyclophosphamide, Doxorubicin, Etoposide, Lenograstim, Neutropenia, Small-cell-lung-cancer
  • RePEc:wkh:phecon:v:24:y:2006:i:5:p:443-452
Language
  • English
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