Cost-effectiveness of bevacizumab-based therapy versus cisplatin plus pemetrexed for the first-line treatment of advanced non-squamous NSCLC in Korea and Taiwan

Aims: The aim of this analysis is to investigate the mean incremental costs and life expectancy associated with two first-line treatments for advanced non-squamous non-small cell lung cancer (NSCLC) in Korea and Taiwan; bevacizumab plus cisplatin and gemcitabine (BevCG) and cisplatin plus pemetrexed (CP). Methods: A health economic (area under curve) model with three health states was developed to assess health outcomes (life-years gained [LYG]), direct costs, and incremental cost-effectiveness ratio (ICER). Progression-free survival (PFS) and overall survival (OS) were derived from randomized clinical trials and used in an indirect comparison in order to estimate their cost effectiveness. A life-time horizon was used. Costs and outcomes were discounted yearly by 5% in Korea and by 3% in Taiwan. Results: The incremental LYG for the BevCG patients compared with patients treated with CP were 1.10 (13.2months) in Korea and 1.19 (14.3months) in Taiwan. The incremental costs were 37439968 ($33322) in Korea and NT$1910615 ($64541) in Taiwan. The incremental cost-effectiveness ratio was 34064835 ($30318) in Korea and NT$1607960 ($54317) in Taiwan. The inputs tested in one-way sensitivity analyses had very little impact on the overall cost effectiveness. Conclusion: This analysis shows that BevCG is more costly but is also associated with additional life-years in Korea and Taiwan. The ICER per LYG suggests that BevCG is a cost-effective therapy when compared to CP for patients with advanced NSCLC in Korea and Taiwan.