Cost-effectiveness of maintenance pemetrexed in patients with advanced nonsquamous-cell lung cancer from the perspective of the Swiss health care system.

OBJECTIVES: A recent randomized study showed switch maintenance with pemetrexed after nonpemetrexed-containing first-line chemotherapy in patients with advanced nonsmall-cell lung cancer to prolong overall survival by 2.8 months. We examined the cost-effectiveness of pemetrexed in this indication, from the perspective of the Swiss health care system, and assessed the influence of the costs of best supportive care (BSC) on overall cost-effectiveness. METHODS: A Markov model was constructed based on the pemetrexed maintenance study, and the incremental cost-effectiveness ratio (ICER) of adding pemetrexed until disease progression was calculated as cost per quality-adjusted life-year gained. Uncertainties concerning the costs of BSC on the ICER were addressed. RESULTS: The base case ICER for maintenance therapy with pemetrexed plus BSC compared to BSC alone was €106,202 per quality-adjusted life-year gained. Varying the costs for BSC had a marked effect. Assuming a reduction of the costs for BSC by 25% in the pemetrexed arm resulted in an ICER of €47,531 per quality-adjusted life-year, which is below predefined criteria for cost effectiveness in Switzerland. CONCLUSIONS: Switch maintenance with pemetrexed in patients with advanced nonsquamous-cell lung cancer after standard first-line chemotherapy is not cost-effective. Uncertainties on the resource use and costs for BSC have a large influence on the cost-effectiveness calculation and should be reported in more detail.

Cost-effectiveness of adjuvanted influenza vaccination of healthy children 6 to 60 months of age.

This study estimated the health and economic outcomes of universal administration of a adjuvanted influenza vaccine to healthy preschool children, as compared with current immunization practice. A Markov model simulated a cohort of 3 million children and their households undergoing five influenza seasons. Assuming a vaccine uptake rate of 30%, at the current acquisition cost of Euro 5.50 per vaccine dose influenza vaccination (two doses for unprimed children) of 6- to 60-month- (5-year) old children averted more than 1 million clinical influenza episodes and saved Euro 63 million, from the perspective of the Italian society. From the perspective of the Italian health care service, influenza vaccination of 6- to 60- and of 6- to 24-month-old children cost Euro 10,000 and Euro 13,333 per quality-adjusted life year (QALY) saved, respectively. Administration of a adjuvanted influenza vaccine to children aged 6 to 60 months was highly cost-effective for the health care service and cost saving for the society.