Cost-Effectiveness of Pemetrexed as First-Line Maintenance Therapy for Advanced Nonsquamous Non-small Cell Lung Cancer Robert Klein, MS, Ron Wielage,

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Cost-Effectiveness of Pemetrexed as First-Line Maintenance Therapy for Advanced Nonsquamous Non-small Cell Lung Cancer Robert Klein, MS, Ron Wielage, MA,

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Cost-Effectiveness of Pemetrexed as First-Line Maintenance Therapy for Advanced Nonsquamous Non-small Cell Lung Cancer Robert Klein, MS, Ron Wielage, MA, MPH, Catherine Muehlenbein, MPH, MBA, Astra M. Liepa, PharmD, Steve Babineaux, MS, RPh, Anthony Lawson, MA, Lee Schwartzberg, MD Journal of Thoracic Oncology Volume 5, Issue 8, Pages 1263-1272 (August 2010) DOI: 10.1097/JTO.0b013e3181e15d16 Copyright © 2010 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Tree diagram of health states. Every 3 weeks, the model cohort is redistributed among the following health states: progressive disease, stable disease, second-line treatment, stable disease without chemotherapy, progressive disease without chemotherapy, end-of-life care, and death. Bev, bevacizumab; chemo, chemotherapy; Erl, erlotinib; Pem, pemetrexed. Journal of Thoracic Oncology 2010 5, 1263-1272DOI: (10.1097/JTO.0b013e3181e15d16) Copyright © 2010 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Effect of select assumptions and uncertainty in model inputs in predicting the cost-effectiveness of maintenance therapy with Pem compared with observation in patients with advanced NSCLC. This tornado diagram shows that most reasonable changes in input parameters had little impact on the ICER for maintenance Pem to observation. Base case ICER for maintenance Pem versus observation was $122,371 per LYG. When a range of input values was modeled, the red portion of the bar corresponds to the effect of the lower input value and the blue portion of the bar corresponds to the higher value. ICER, incremental cost-effectiveness ratio; LYG, life-year gained; NSCLC, non-small cell lung cancer; Pem, pemetrexed. Journal of Thoracic Oncology 2010 5, 1263-1272DOI: (10.1097/JTO.0b013e3181e15d16) Copyright © 2010 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Willingness-to-pay for pemetrexed maintenance therapy compared with observation. Approximately 90% of ICERs estimated using samples varying costs and SAE event rates were between $100,000 and $150,000 per LYG. ICER, incremental cost-effectiveness ratio; LYG, life-year gained; SAE, serious adverse event. Journal of Thoracic Oncology 2010 5, 1263-1272DOI: (10.1097/JTO.0b013e3181e15d16) Copyright © 2010 International Association for the Study of Lung Cancer Terms and Conditions