Pharmacoeconomic Research For Advanced Non-small-cell Lung Cancer Based On Decision Model

Objectives1. In order to provide theoretical basis for furtuer applying of decision model for pharmacoeconomic evaluation, the decision model and how models can be made probabilistic were reviewed and discussed.2. A general framework of pharmacoeconomic evaluation model for advanced non-small cell lung cancer (NSCLC) was established, and methods of probability and cost were developed with reference to the general model.3. To verify the feasibility and the manipuility of decision modeling for pharmacoeconomics and the established model of advanced NSCLC, two specific examples of continuation maintenance pemetrexed therapy and gefitinib in maintenance setting were exhibited.MethodsIn this paper, decision model for pharmacoeconomics and was discussed reviewed and its application in advanced NSCLC was studied by analysis of concepts, comparation, model, specific examples and documentation.1. A general decision model of advanced NSCLC was developed based on clinical data of an upper first-class hospital and phase III clinical trial.2. On the basis of clinical survival data, a method of probability calculation for the model establised of advanced NSCLC was built by WinBUGs and R software.3. A cost accounting method for meeting the request of the evaluation model framework established was performed, with reference to internationally accepted methods and requirements. The healthcare costs associated with treating advanced NSCLC was provided, including specialised knowledge about the time-and health status-related medical costs that patients may anticipate.Results1. A complete theoretical system, to some extent, was discussed, which provides the theoretical basis of methodology for decision-making model of pharmacoeconomic evaluation, and that could server as a supplement of decision-making model for the China Guidelines for Pharmacoeconomic Evaluations.2. A basic Markov model structure was established for advanced NSCLC; and then a method of probability calculation, with application of Kolmogorov forward equation, was provided to suit the model established.3. The health costs associated with treating advanced NSCLC, including more specialized knowledge about time-and health status-ralated medical costs were evaluated systematacially, which is also the first paper to present empirically estimated China-specific costs associated with the treatment of NSCLC by disease stage.4. The feasibility and maneuverability, of decision model for pharmacoeconomic evaluation and the evaluation model established for advanced NSCLC, were tested by the specific examples.5. From the perspective of the Chinese health care system, continuation maintenance pemetrexed therapy after four cycles of cisplation and pemertrexed chemotherapy (CP therapy) for advanced nonsquamous NSCLC would increase benefits in10-year time horizon with incremental costs of＄124,793per quality-adjusted life-year (QALY) gained.6. Maintenance gefitinib therapy after four cycles of stand first-line platinum-based chemotherapy for patients with locally advanced/metastatic NSCLC would increase benefits with incremental costs of￥133677per QALY gained, also from the perspective of the Chinese health care system and in a10-year time horizon.Conclusion1. Decision model, as a vital tool for decision analysis, can be widely used in pharmacoeconomic evaluation. Making decision models probabilistic is an important part of the decision-making model.2. Three-state Markov model can be used as the basic model structure for pharmacoeconomic evaluation of advanced NSCLC.3. How a unified method of rate and probability estimated was showed for different data structures using the WinBUGs software, with application of Kolmogorov forward equation.4. The cost data structure which has been built for the evaluation model established based on Bootstrap method is suitable for pharmacoeconomic research of advanced NSCLC in China. 5. From the Chinese perspective of health care system, continuation maintenance pemetrexed after induction CP therapy for patients with advanced non-squamous NSCLC is likely to be unfavourable with regard to cost-effectiveness. However, in areas with a high per-capita GDP, continuation maintenance pemetrexed may be cost-effective.6. Maintenance gefitinib therapy after the standard platinum-based chemotherapy of four cycles in patients with locally advanced/metastatic NSCLC is likely to be not cost-effective for Chinese mainland, from the Chinese health care system perspective. Local governments, with different economic level however, could take fully into account covering maintenance gefitinib treatment. Because for rich regions (the per-capita GDP> Y55000, such as Shanghai and Beijing), the new strategy seems to be a reasonable option, and if the per-capita GDP ranges from Y36666to Y55000, the maintenance therapy may be favourable in terms of the different cost-effective probabilities.7. The results of special examples could provide referential information for healthcare decision makers.