OBJECTIVES: Chemotherapy combinations and biologics have increased the overall survival rate for patients with advanced non-small cell lung cancer (NSCLC), but at a very high cost. We evaluated the effectiveness of chemotherapy/targeted therapy among elderly patients with NSCLC stratified by age groups, and then assessed the cost utility of treatment.
STUDY DESIGN: Retrospective cohort study.
METHODS: SEER (Surveillance, Epidemiology, and End Results) program- and Medicare-linked data were used to estimate the total healthcare cost, life-years, and quality-adjusted life-years (QALYs) for elderly (aged 65-94 years) stage IIIB/IV NSCLC patients diagnosed between 2006 and 2009. Patients were grouped into “no chemotherapy,” “platinum-based chemotherapy,” and “platinum + targeted therapy” cohorts, and propensity score matching was performed. Cost-effectiveness was evaluated with the incremental cost-effectiveness ratio (ICER) and net monetary benefit. Uncertainty was accounted for by presenting cost-effectiveness acceptability curves (CEACs). A 3% discounting was applied to costs (2014 US$) and effectiveness.
RESULTS: A total of 4884 patients were included in the study, with 1628 in each treatment group. The ICER for platinum-based chemotherapy versus no chemotherapy was $124,645 per QALY gained; for platinum + targeted therapy versus platinum-based chemotherapy, it was $864,327 per QALY gained. Similar results were obtained for alternate scenarios and age groups. The CEAC showed that platinum-based chemotherapy was nearly 100% cost-effective at a willingness-to-pay threshold of $200,000 per QALY, while platinum + targeted therapy was 70% cost-effective at a willingness-to-pay threshold of $1 million per QALY.
CONCLUSIONS: Platinum-based chemotherapy may be cost-effective compared with no chemotherapy for the overall elderly population and by age group. However, platinum + targeted therapy was not cost-effective compared with the use of platinum-based therapy alone.
