Economic evaluation of second line treatment of non-small cell lung cancer under the Brazilian private healthcare system perspective

Abstract

Introduction: Lung cancer has high incidence and mortality in Brazil. Most tumors are non-small cell (NSCLC) and approximately 54% present with metastases at diagnosis. The aim of this study was to develop a cost-minimization analysis evaluating the use of gefitinib versus docetaxel, pemetrexed and erlotinib in the second line treatment of advanced NSCLC, from the perspective of the Brazilian private health care system. Methods: A cost analysis was developed considering the treatment costs with gefitinib, docetaxel, pemetrexed and erlotinib for advanced NSCLC patients eligible for second line. The time horizon of the analysis was 1 year. Only direct medical costs were included in the analysis, considering: drugs, infusion of intravenous protocols, treatment of adverse events and patients’ monitoring. The costs of each drug were weighted by the average number of treatment cycles with each protocol, obtained from clinical studies and international publications. Results: The costs per 21-day cycle for each protocol were: R$2,239.28 for gefitinib, R$5,850.22 for docetaxel, R$11,170.92 for pemetrexed and R$3,793.16 for erlotinib. Considering the average duration of each treatment, the projected total average cost per patient in the time horizon of 1 year was R$16.394,26, R$31.746,14, R$52.032,46 and R$24.775,95 for gefitinib, docetaxel, pemetrexed and erlotinib, respectively. Conclusion: Gefitinib resulted in lower treatment costs when compared to docetaxel, pemetrexed and erlotinib, with equivalent efficacy results, in a 1 year time horizon.