The cost-effectiveness of navelbine alone or in combination with cisplatin in comparison to other chemotherapy regimens and best supportive care in stage IV non-small cell lung cancer

An economic evaluation was undertaken, using data from European and Canadian randomised controlled trials of chemotherapy in advanced non-small cell lung cancer (NSCLC), to determine the cost and cost-effectiveness of single-agent vinorelbine (Navelbine, NVB) therapy and NVB in combination with cisplatin (NVB-P) compared to vindesine in combination with cisplatin (VDS-P), standard regimens including VP-16-cisplatin (VP-16-P) and vinblastine-cisplatin (VLB-P) and best supportive care (BSC). The Population Health Model (POHEM) developed by Statistics Canada was used to model the cost of care per patient, the total burden of cost to the Canadian healthcare system and the cost-effectiveness of the therapeutic interventions relative to BSC and to standard chemotherapy regimens, expressed as the cost per life year gained (LYG). Based on this analysis, VLB-P proved to be the most cost-effective chemotherapy regimen relative to BSC, as it increased average survival by 0.27 years while reducing costs by $3265 per case. NVB-P increased survival to a greater degree (0.44 years/patient) while inpatient administration increased costs by $2451 per case, for a cost-effectiveness ratio of $5551 per LYG. Outpatient administration, which reduced the cost of care per case by $473, was shown in the model to be the most cost-effective way to administer this regimen. Relative to VP-16-P and VLB-P, outpatient NVB-P regimen proved to be cost-effective at $7902 and $16404 per LYG, respectively. Based on our estimates, a variety of chemotherapy regimens, including outpatient NVB-P, are cost-effective in the management of advanced (Stage IV) NSCLC and competitive with some commonly used healthcare interventions. Therefore, cost and cost-effectiveness should not be barriers to the utilisation of NVB-P therapy in Canada.