Clinicians are continually seeking new options in the treatment of malignant pleural mesothelioma. In patients with unresectable disease, prognosis is poor, and many different therapies have been tried. One phase III study (EMPHACIS) had shown some promising results with the use of pemetrexed combined with cisplatin. Researchers and economists from Australia, the United States, and the United Kingdom developed a health economic model to better understand if the therapeutic gains of this combination therapy translated into cost-effective care compared with standard treatment and alternative treatments used in the United Kingdom.

To properly evaluate the cost effectiveness of the combined therapy, two models were developed: (1) to model survival outcomes over time using patient-level data and (2) to compare the costs and outcomes using means and median data, principally against a combination of mitomycin C, vinblastine, and cisplatin (MVP treatment); vinorelbine monotherapy; and palliation of symptoms.

The researchers found that in the first model analysis, the total per-patient cost of pemetrexed and cisplatin was between $17,409 and $17,887, yielding an average increase of quality-adjusted life-years per patient of 0.20–0.28, or up to 3.36 mo. They calculated a range of incremental cost of per life-year gained values of $40,597 to $136,015, which indicates questionable cost effectiveness of this approach. In the second analysis, rather than using patient-level data, the means and medians were utilized, the incremental cost effectiveness ratio was estimated to be from $28,934 to $63,570, which depending on the currency exchange rate, could be within the acceptable range (< $50,000/life-yr gained).

Cordony A, Le Reun C, Smala A, et al: Costeffectiveness of pemetrexed plus cisplatin: Malignant pleural mesothelioma treatment in UK clinical practice. Value Health 2008;11:4-12.