By Steven Reinberg
NEW YORK (Reuters Health) – Although there is statistically no difference in survival or cancer-related quality-of-life after treatment for non-small-cell lung cancer with carboplatin plus paclitaxel or cisplatin plus vinorelbine, carboplatin plus paclitaxel therapy is significantly more expensive.
"These two regimens, which are both equally efficacious. However, carboplatin plus paclitaxel, which is the most often prescribed regimen in the US, did show a slight improvement in reducing nausea," Dr. Scott D. Ramsey, from the Fred Hutchinson Cancer Center Research Center, Seattle, told Reuters Health.
"But you have to ask yourself if this slight difference is worth the $8000 to $9000 more for the carboplatin-paclitaxel regimen," he said.
Writing in the February 20th issue of the Journal of the National Cancer Institute, Dr. Ramsey and colleagues compared the total healthcare costs of each treatment over 24 months after the start of treatment.
The cost analysis was performed as part of the Southwest Oncology Group multicenter, randomized phase III trial of 444 patients with advanced non-small-cell lung cancer. The trial was designed to compare the efficacy of the two treatment regimens.
The average cancer-related cost of cisplatin plus vinorelbine therapy was $40,292 compared with $48,940 for carboplatin plus paclitaxel therapy (p = 0.004), the researchers report.
For patients receiving carboplatin plus paclitaxel therapy, drug costs (p = 0.0003), ($11,863 more than cisplatin plus vinorelbine) and cost of medical procedures (p < 0.0001) were significantly higher compared with cisplatin plus vinorelbine therapy. In cisplatin plus vinorelbine therapy, the chemotherapy delivery costs were significantly higher compared with carboplatin plus paclitaxel therapy (p < 0.0001), Dr. Ramsey's team found.
There were no cost differences between the treatments for the cost of blood products, supportive care medications, nonprotocol-related inpatient or outpatient care, and nonprotocol chemotherapy, they add.
"Because the carboplatin plus paclitaxel regimen required less frequent dosing and was expected to have fewer side effects than cisplatin plus vinorelbine, we hypothesized that higher initial drug costs would be offset by the lower costs of both protocol-related treatment and treatment of adverse effects related to therapy," Dr. Ramsey and colleagues comment.
"Although protocol-related chemotherapy administration costs were lower in the carboplatin plus paclitaxel arm, these savings did not offset the higher drug and other resource costs for patients treated with this regimen," the authors conclude.