1057 The health economics of lung cancer and an estimate of the cost effectiveness of single agent gemcitabine in stage IV NSCLC

Statistics Canada has developed a model for costing lung cancer management and evaluating the cost-effectiveness of new therapeutic interventions, based on Canadian practice. This costing model was used to compare costs of gemcitabine versus best supportive care (BSC) (no chemotherapy) for stage IV NSCLC. Gemcitabine costs are based on chemotherapy preparation time, nursing administration time, cost of all supplies, clinic visits, and nursing and physician assessments for gemcitabine administration assuming a weekly × 3 treatment schedule every 4 weeks. As the price of gemcitabine has yet to be determined, a variety of costs per cycle were used ($Cdn 1,000–1,800). The hospitalization costs for BSC were based on the NCIC BR5 trial of BSC versus chemotherapy. The 1993 cost for the BSC arm (including terminal care) was $Cdn 20,914. The incremental cost per case to manage with gemcitabine was $Cdn 1258 (assuming $Cdn 1000 per cycle). The estimated cost per life year gained varied from $Cdn 3193 to 9529 depending on the cost of drug per treatment cycle. This high cost effectiveness is achieved in part because of the reduction in hospital days for terminal care in treated stage IV patients. The cost effectiveness analysis was repeated assuming lower survival. Cost effectiveness decreased, but even in the worst case scenario ($Cdn 1800/cycle; survival −50%), the cost per life year gained was still only $Cdn 16,230. Based on this model, gemcitabine therapy for advanced NSCLC is cost-effective over a range of costs per cycle even when sensitivity analyses are performed that reduce survival expectations.