Cost-Effectiveness of Adding Rh-Endostatin to First-Line Chemotherapy in Patients With Advanced Non-Small-Cell Lung Cancer in China

Background: Adding rh-endostatin to standard platinum-based chemotherapy may significantly improve progression-free and overall survival in patients with advanced non small cell lung cancer (NSCLC), but the cost-effectiveness of this practice is unclear. Objective: The purpose of this cost-effectiveness analysis was to estimate the effects of adding rh-endostatin to standard chemotherapy in patients with advanced NSCLC on health and economic outcomes in China. Methods: A semi-Markov model was constructed to track 3-week patient transitions between 3 health states: progression-free survival, progressed survival, and death. Probabilities were derived mainly from the results of a pivotal Phase III trial assessing the addition of rh-endostatin to standard first-line chemotherapy with vinorelbine cisplatin in patients with advanced NSCLC. Costs were estimated from the perspective of the Chinese health care system, and the analysis was run over a 10-year time horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER) of adding rh-endostatin at a willingness-to-pay (WTP) threshold of 3 x the per-capita gross domestic product (GDP) per quality-adjusted life-year (QALY) gained. One-way and probabilistic sensitivity analyses were performed. Results: According to the model, treatment with rh-endostatin plus standard chemotherapy would increase overall survival by 0.63 years and 0.35 QALYs per patient compared with standard chemotherapy, at an additional cost of $8402.60. The ICER for adding rh-endostatin to chemotherapy was $24,454.25/QALY gained (at a 3% discounted rate). On 1-way sensitivity analysis, the utility value of progression-free survival was the most influential factor on the results, followed by the cost of rh-endostatin. On probabilistic sensitivity analysis, the probabilities of cost-effectiveness varied by region due to discrepant per-capita GDPs in China. Modeling to extrapolate clinical survival beyond trial completion was the main limitation. Conclusion: The findings from the present analysis suggest that the addition of rh-endostatin to standard first-line chemotherapy is unlikely to be cost-effective. However, at a high WTP, rh-endostatin might be a cost-effective treatment option. (Clin Ther. 2011;33: 1446-1455) (C) 2011 Elsevier HS Journals, Inc. All rights reserved.