Cost–utility analysis of chemotherapy in symptomatic advanced nonsmall cell lung cancer

When using chemotherapy in patients with a short life expectancy, outcomes such as symptom improvement or clinical benefit receive increasing attention. Outcomes of subjective benefit to the patient can be rated as a utility in order to perform health economic analyses and comparisons with other treatment conditions. A cost–utility analysis has been performed alongside a prospective randomised clinical trial comparing single agent gemcitabine to cisplatin-based chemotherapy in symptomatic advanced nonsmall cell lung cancer patients. Global quality of life as well as resource utilisation data were collected during first-line chemotherapy for both treatment arms. Incremental costs, utilities and cost–utility ratio were calculated. Per patient, an incremental cost of \#8364;1,522 was obtained for gemcitabine compared to cisplatin–vindesine, mainly as a consequence of the direct cost of the cytotoxic drugs. When combined with utilities, this resulted in an incremental cost–utility ratio for gemcitabine of \#8364;13,836 per quality-adjusted life year gained. In conclusion, although the least expensive strategy is cisplatin–vindesine, the greater clinical benefit of gemcitabine, resulting in an acceptable incremental cost–utility ratio as compared with other healthcare interventions, balances its higher cost. The gains in subjective outcome achieved with palliative chemotherapy are critical from both a clinical and a health economic point of view.