Brunner, M

Chouaid, C

Vergnenegre, A

Walzer, S

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PCN43 THE COST OF TREATING GRADE 3/4 ADVERSE EVENTS RELATED TO FIRST-LINE THERAPY WITH BEVACIZUMAB PLUS CHEMOTHERAPY VERSUS CETUXIMAB PLUS CISPLATIN/VINORELBINE FOR PATIENTS WITH ADVANCED NON-SMALL CELL LUNG CANCER (NSCLC) IN FRANCE 

A264 Paris Abstracts
patients versus chemotherapy alone. Cetuximab, a MAb targeting EGFR, has also 
shown some improvements in these patients (median PFS 4.8 months) when combined 
with cisplatin plus vinorelbine (FLEX study). The aim of this study was to compare 
the costs of treating NSCLC with BCG or CVC in Germany. METHODS: A Markov 
model was used to compare drug and administration costs associated with treating 
advanced or recurrent NSCLC with BCG or CVC. The model assumes patients move 
from non-progressive to progressed disease prior to death, according to transition 
probabilities derived from an indirect comparison (IC) of BCG and CVC efﬁcacy in 
terms of PFS using respective pivotal trial data and appropriate IC methodology. Cost 
data were derived from local sources. Drug costs assumed chemotherapy was given 
for up to 6 cycles, cetuximab was administered initially at 400 mg/m2 (then 250 mg/m2 
weekly) until progression and bevacizumab 7.5 mg/kg was administered until progres-
sion. Sensitivity analyses were run with different patient characteristics. RESULTS: 
The mean total cost of BCG treatment was a4,713 less per patient than CVC (a28,342 
versus a33,055, respectively). Adding bevacizumab to chemotherapy was less costly 
than CVC (a18,796 versus a29,502, respectively) and the administration cost for BCG 
was also less costly than for CVC (a391 versus a1,179, respectively). CONCLU-
SIONS: Bevacizumab targeted-therapy is less costly than cetuximab in Germany, thus 
from a budget perspective, offers the best value for money strategy for improving 
outcomes in patients with advanced non-squamous NSCLC. Furthermore, costs 
savings with BCG in Germany will be increased since gemcitabine has recently come 
off-patent.
PCN42
ECONOMIC EVALUATION OF THE USE OF HAEMOSTATIC SEALANT 
PATCH FOR PULMONARY LOBECTOMY PROCEDURE
Droghetti A1, Di Stasi F2, Pantaleoni M3, Muriana G1
1Carlo Poma Hospital, Mantova, Italy, 2Nycomed SpA, Milano, Italy, 3IMS Health, Milano, Italy
OBJECTIVES: To evaluate direct costs of pulmonary lobectomy hospitalization com-
paring two different surgical techniques: stapler (ST) versus electrocautery and hae-
mostatic sealant patch (ES) to Italian Hospitals. METHODS: The cost comparison 
analysis was based on the clinical pathway drawn up from the information provided 
by the medical team of the hospital enrolled. Resource use data including staff time, 
diagnostic tests, drugs and consumables came from a randomized controlled trial 
including 40 patients (20 in each group). Technology equipment utilization and 
maintenance, operating room costs, administrative and general costs, and 30 days post 
surgery hospital resource consumption were also considered. Overheads were allo-
cated on the basis of hospitalization rate and procedures weight. Unit costs were col-
lected either from hospital accounting or regional tariffs for specialist services, when 
hospital data are not available. The analysis was conducted from hospital perspective. 
RESULTS: On average, a patient submitted to a pulmonary lobectomy costs around 
a10,000. This amount could vary from a9,200 (using ES) to a10,800 (using ST). Cost 
savings in the ES group were driven by the lower incidence of complications. In fact 
the lower overall incidence (50% vs. 95%, P  0.0001) and duration of air leakage 
(1.7 days vs. 4.5 days, P  .0001) in the ES group impacts signiﬁcantly on the mean 
time to hospital discharge (11 days vs. 14.3 days) and consequently on costs. Exclud-
ing general costs the main key cost driver is staff time (42%), secondly the consum-
ables (34%) and then operating room costs (12%). CONCLUSIONS: There is an 
overall saving of around a1600 using electrocautery dissection and the haemostatic 
sealant patch for a pulmonary lobectomy. We found that among patients submitted 
to this surgery procedure, ES can signiﬁcantly reduce air leakage incidence and dura-
tion and decrease hospitalization rates. However further multi-centre research should 
be developed considering different clinical and organizational settings.
PCN43
THE COST OF TREATING GRADE 3/4 ADVERSE EVENTS RELATED TO 
FIRST-LINE THERAPY WITH BEVACIZUMAB PLUS CHEMOTHERAPY 
VERSUS CETUXIMAB PLUS CISPLATIN/VINORELBINE FOR PATIENTS 
WITH ADVANCED NON-SMALL CELL LUNG CANCER (NSCLC)  
IN FRANCE
Chouaid C1, Vergnenegre A2, Brunner M3, Walzer S4
1Hopital Saint antoine, APHP, Paris, France, 2CHU Limoges, Limoges, France, 3Outcomes 
International, Basel, Switzerland, 4F. Hoffmann-La Roche Pharmaceuticals AG, Basel, 
Switzerland
OBJECTIVES: Novel combination therapies for advanced NSCLC can offer improved 
survival over chemotherapy alone. Besides effectiveness new therapies must also dem-
onstrate acceptable tolerability. Furthermore, toxicities can result in potentially high 
additional treatment costs. This analysis thus explores the treatment costs of adverse 
events (AEs) related to two newly available ﬁrst-line NSCLC therapies consisting 
of either Bevacizumab (BEV) combined with chemotherapy (CT) or Cetuximab (C) 
combined with cisplatin  vinorelbine (CV). METHODS: All published AEs and their 
incidences as reported in the AVAiL trial (7.5 mg/kg, Reck et al. 2009) or the E4599         
trial (15 mg/kg, Sandler et al. 2006) were taken into consideration for the BEV            CT 
analyses, whereas AE data for the CCV regimen was retrieved from the FLEX trial 
(Pirker et al. 2009). A systematic literature search was performed to collect published 
information on standard treatment patterns and costs of AEs. Two oncologists in 
France were additionally interviewed to substantiate and complement the data on 
medical resource utilization for the AEs under study. These resource use items were 
then assigned unit costs (charges) based on tariffs for France. A model was subse-
quently developed and populated with the collected data to calculate total average 
per-patient AE costs associated with the two compared therapy regimens. RESULTS: 
Our analysis shows substantially lower overall per-patient treatment costs for the 
grade 3/4 AE proﬁles observed for both BEV regimens (cisplatin/gemcitabine; carbo-
platin/paclitaxel) than those for the severe AEs observed in the FLEX trial (a1,166 
and a419 versus a2,236). The cost differences favouring BEVCT are mainly attribut-
able to lower incidences of febrile neutropenia, dyspnoea, anaemia, sepsis, and respira-
tory failure. CONCLUSIONS: BEVCT shows better tolerability and lower AE 
treatment costs as compared to CCV. Coupled with its favorable effectiveness, 
BEVCT should be considered as therapy of choice for patients with advanced 
NSCLC.
PCN44
TREATMENT COSTS OF GRADE 3/4 ADVERSE EVENTS RELATED TO 
FIRST-LINE THERAPY WITH BEVACIZUMAB PLUS CHEMOTHERAPY 
VERSUS CETUXIMAB PLUS CISPLATIN/VINORELBINE FOR PATIENTS 
WITH ADVANCED NON-SMALL CELL LUNG CANCER (NSCLC)  
IN SPAIN
de Castro Carpeño J1, Banz K2, Castro AJ3
1La Paz University Hospital, Madrid, Spain, 2Outcomes International, Basel, Switzerland, 
3Roche Farma, Madrid, Spain
OBJECTIVES: Novel combination therapies for advanced NSCLC can offer improved 
survival over chemotherapy alone. However, acceptable tolerability of these new 
therapies is important also in view of the potentially high costs involved in the manage-
ment of severe adverse events (AEs). This analysis explores the AE treatment costs 
related to ﬁrst-line therapy with Bevacizumab (BEV) in combination with chemother-
apy (CT) versus Cetuximab (C) in combination with cisplatin  vinorelbine (CV) in 
patients with advanced NSCLC in Spain. METHODS: All published AEs and their 
incidences as reported in the AVAiL trial (7.5 mg/kg, Reck et al. 2009) and in the         
E4599 trial (15 mg/kg, Sandler et al. 2006) were considered for BEV         CT, whereas 
AE data for the CCV regimen was retrieved from the FLEX trial (Pirker et al. 2009). 
To capture published information on standard treatment patterns and treatment costs 
of AEs, a systematic literature search was performed. Moreover, an oncologist in Spain 
was interviewed to collect additional data on medical resource utilization for the AEs 
under study. These resource use items were then assigned unit costs reﬂective of the 
Spanish health care system. A model was subsequently developed and populated with 
the collected data to calculate total average per-patient AE costs associated with the 
two compared therapy regimens. RESULTS: Treatment costs per patient related to 
grade 3/4 AEs as reported in both BEV NSCLC trials (AVAiL and E4599) are lower 
than those for AEs observed in the FLEX trial (a1192 and a577 vs. a2396). The 
 differences favouring BEVCT are mainly due to lower incidences of neutropenic 
events, leukopenia, sepsis, and respiratory failure when compared to a CCV regimen. 
CONCLUSIONS: BEVCT shows better tolerability and lower AE treatment costs 
as compared to CCV. Coupled with its favorable effectiveness, BEVCT should 
be considered as therapy of choice for patients with advanced NSCLC.
PCN45
COST COMPARISON BETWEEN 90Y IBRITUMOMAB TIUXETAN 
CONSOLIDATION AND RITUXIMAB MAINTENANCE POST-
CHEMOTHERAPY IN NAÏVE PATIENTS WITH B-CELL NON-HODGKIN’S 
LYMPHOMA IN SPAIN
Tomas JF1, Febrer L2, Piñol C2, Musi E2
1MD Anderson Cancer Center Spain, Madrid, Spain, 2Bayer HealthCare, Barcelona, 
Catalonia, Spain
OBJECTIVES: 90Y Ibritumomab Tiuxetan has been recently approved in the European 
Union as consolidation therapy after remission induction in previously untreated 
patients with B-cell Non-Hodgkin’s Lymphoma (NHL). As a result, the objective of 
the present study was to compare its treatment costs vs. Rituximab maintenance ones 
in Spain. METHODS: A microcosting exercise was performed with Microsoft Excel 
considering Spanish medication and premedication costs for both therapeutic alterna-
tives. Also administration costs were considered. The perspective for cost calculation 
was that of the National Health System. Drug costs were obtained from IMS, posology 
was derived from drug technical speciﬁcations and premedication patterns were 
assessed by expert opinion. Other costs were obtained from specialized sources. Costs 
were expressed in euros 2008. No discounting was needed. The schema of the PRIMA 
study was considered to determine Rituximab maintenance administration pattern. It 
was taken into account that 250 mg/m2 of Rituximab are administered twice, previous 
to 90Y Ibritumomab Tiuxetan consolidation, as premedication. RESULTS: 90Y Ibritu-
momab Tiuxetan consolidation represented a 32% reduction in treatment costs with 
respect to Rituximab maintenance for hospitals in Spain. Absolute ﬁgures accounting 
for medication, premedication, drug preparation and administration costs for both 
therapeutic options were a15,675 for 90Y Ibritumomab Tiuxetan consolidation and 
a22,934 for Rituximab maintenance. If we accounted only for drug costs, absolute 
ﬁgures were: a15,203 for 90Y Ibritumomab Tiuxetan and a21,044 for Rituximab. 
Regarding premedication costs, 16% of 90Y Ibritumomab Tiuxetan consolidation costs 
were due to premedication administered, which is mainly Rituximab and its premedi-
cation, paracetamol and diphenhydramine. CONCLUSIONS: 90Y Ibritumomab 
Tiuxetan consolidation administered once post-chemotherapy in previously untreated 
patients with B-cell NHL is less costly than Rituximab maintenance administered every 
two months for two years in Spain.


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PCN43 THE COST OF TREATING GRADE 3/4 ADVERSE EVENTS RELATED TO FIRST-LINE THERAPY WITH BEVACIZUMAB PLUS CHEMOTHERAPY VERSUS CETUXIMAB PLUS CISPLATIN/VINORELBINE FOR PATIENTS WITH ADVANCED NON-SMALL CELL LUNG CANCER (NSCLC) IN FRANCE

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