The cost-effectiveness of a NSCLC patient assistance program for pemetrexed maintenance therapy in People’s Republic of China

Figures & data

Table 1 Clinical model inputs

Input	Base case	Range	Source
Patients
Patient BSA	1.72 m^2	1.38–2.06 m^2	Zeng et al^Citation21
Effectiveness
PFS hazard ratio, pemetrexed vs BSC	0.60	0.50–0.73	PARAMOUNT^Citation17
OS hazard ratio, pemetrexed vs BSC	0.78	0.64–0.96	PARAMOUNT^Citation17
Utility
Utility, progression-free disease	0.65	0.26–0.87	Zeng et al^Citation21
Utility, progressed disease	0.47	0.19–0.56	Zeng et al^Citation21
Adverse event rates
Anemia (pemetrexed)	6.4%	5.12%–7.68%	PARAMOUNT^Citation17
Neutropenia (pemetrexed)	5.8%	4.64%–6.96%	PARAMOUNT^Citation17
Fatigue (pemetrexed)	4.7%	3.76%–5.64%	PARAMOUNT^Citation17
Anemia (BSC)	0.6%	0.48%–0.72%	PARAMOUNT^Citation17
Neutropenia (BSC)	0.0%	0.00%–0.00%	PARAMOUNT^Citation17
Fatigue (BSC)	1.1%	0.88%–1.32%	PARAMOUNT^Citation17

Abbreviations: BSA, body surface area; BSC, basic standard care; OS, overall survival; PFS, progression-free survival.

Table 2 Cost inputs

Input	Base case	Range	Source
Drug costs
Pemetrexed 500 mg vial cost	$1,820	$1,456–$2,184	GBI Health^Citation23
Pemetrexed 100 mg vial cost	$364	$291–$437	GBI Health^Citation23
BSC cost (per month)	$2,047	$1,638–$2,456	Zeng et al^Citation21,*
Adverse event costs
Anemia (cost per event)	$538	$431–$646	Zeng et al^Citation21,*
Neutropenia (cost per event)	$467	$374–$561	Zeng et al^Citation21,*
Fatigue (cost per event)	$117	$93–$140	Zeng et al^Citation21,*

Note:

* Data from Zeng X, Peng L, Li J, Chen G, et al, Cost-effectiveness of continuation maintenance pemetrexed after cisplatin and pemetrexed chemotherapy for advanced nonsquamous non-small-cell lung cancer: estimates from the perspective of the Chinese health care system, Clin Ther, 2013;35(1):54–65, Elsevier, copyright 2013.²¹

Abbreviation: BSC, best supportive care.

Figure 1 Real-world PAP impact analysis.

Note: ^aSurviving patients with nonprogressed disease.
Abbreviations: NSCLC, non-small-cell lung cancer; PAP, patient assistance program.

Table 3 Base case results (PAP)

Outcome	Pemetrexed	BSC	Difference
Discounted costs
Induction therapy (pemetrexed)	$12,524	$12,524	$0
Maintenance therapy (pemetrexed)	$0a	N/A
Adverse events	$67	$5	$63
BSC (PFS)	$3,388	$2,394	$994
BSC (PD)	$23,222	$21,211	$2,011
Total cost to payer	$39,202	$36,134	$3,068
Discounted outcomes
QALYs (PFS)	0.30	0.21	0.09
QALYs (PD)	0.44	0.41	0.04
Total QALYs	0.74	0.62	0.13
		ICER	$24,319

Note:

a The cost of pemetrexed for maintenance therapy is covered by the PAP.

Abbreviations: BSC, basic standard care; ICER, incremental cost-effectiveness ratio; PAP, patient assistance program; PD, progressive disease; PFS, progression-free survival; QALYs, quality-adjusted life years.

Figure 2 Tornado diagram.

Abbreviations: ICER, incremental cost-effectiveness ratio; BSC, basic standard care; OS, overall survival.

Figure 3 Cost-effectiveness scatterplot.

Abbreviation: QALYs, quality-adjusted life years.

Figure 4 Cost-effectiveness acceptability curve.

Abbreviations: WTP, willingness to pay; QALY, quality-adjusted life year.

Table 4 Scenario analysis

Scenario	PAP	Non-PAP	Difference
5% scenario
Cost to payer	$36,287	$36,134	$153
Total QALYs	0.63	0.62	0.01
10% scenario
Cost to payer	$36,440	$36,134	$307
Total QALYs	0.64	0.62	0.01
15% scenario
Cost to payer	$36,594	$36,134	$460
Total QALYs	0.64	0.62	0.02
20% scenario
Cost to payer	$36,747	$36,134	$614
Total QALYs	0.65	0.62	0.03
25% scenario
Cost to payer	$36,901	$36,134	$767
Total QALYs	0.66	0.62	0.03

Notes: Each scenario refers to the percentage of patients in the PAP arm on pemetrexed vs BSC at the start of the model. All patients in the non-PAP arm are assigned to BSC.

Abbreviations: PAP, patient assistance program; QALYs, quality-adjusted life years; BSC, basic standard care.

ZengXPengLLiJChenGCost-effectiveness of continuation maintenance pemetrexed after cisplatin and pemetrexed chemotherapy for advanced nonsquamous non-small-cell lung cancer: estimates from the perspective of the Chinese health care systemClin Ther2013351546523328269

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