Raltitrexed plus cisplatin is cost-effective compared with pemetrexed plus cisplatin in patients with malignant pleural mesothelioma

Our plain-English summary of Raltitrexed plus cisplatin is cost-effective compared with pemetrexed plus cisplatin in patients with malignant pleural mesothelioma, by B. Woods, N. Paracha, D.A. Scott, et al (Lung Cancer, 2012).

The study

• Authors: B. Woods, N. Paracha, D.A. Scott, N. Thatcher
• Journal: Lung Cancer
• Published: 2012;75(2):261-7
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: The National Institute for Health and Clinical Excellence (NICE) has previously recommended pemetrexed plus cisplatin for the treatment of patients with advanced malignant pleural mesothelioma (MPM) and WHO performance status 0-1. Subsequent to this appraisal, randomised controlled trial (RCT) data for raltitrexed plus cisplatin and comparing chemotherapy to active symptom control (ASC) has become available, allowing a more complete analysis of the comparative efficacy and cost-effectiveness of first-line chemotherapy in MPM.

Methods: An adjusted indirect comparison is used to estimate the relative efficacy of raltitrexed plus cisplatin and pemetrexed plus cisplatin. A cost-effectiveness model is used to assess the lifetime costs and health outcomes associated with these comparators and ASC. Patient level data from the EORTC 08983 trial are used to estimate baseline progression and survival rates. Relative treatment effects are taken from RCTs; cost and utility data from the literature.

Results: Raltitrexed plus cisplatin and pemetrexed plus cisplatin were not found to be statistically significantly different with respect to overall response, progression free survival or overall survival. The cost-effectiveness analysis found raltitrexed plus cisplatin to be cost-effective at a cost per quality adjusted life year of £13,454 compared to cisplatin and £27,360 compared to ASC. Pemetrexed plus cisplatin is dominated by raltitrexed plus cisplatin as the raltitrexed combination offers marginally higher quality adjusted life years (QALYs) and life years (LYs) at a substantially lower total cost.

Conclusion: Raltitrexed plus cisplatin is a cost-effective first-line treatment for MPM. This conclusion was maintained across a number of sensitivity analyses.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

In plain English

This was a health-economic analysis of chemotherapy for malignant pleural mesothelioma, not a study of asbestos exposure. The authors compared raltitrexed plus cisplatin with pemetrexed plus cisplatin, and with cisplatin alone and active symptom control (care without chemotherapy), from the point of view of the UK National Health Service. Their updated search found no new eligible trials, so they compared the two combinations indirectly using two earlier trials, EORTC 08983 and EMPHACIS. The combinations were not statistically significantly different in tumour response, time without progression, or overall survival (hazard ratio 0.99, 95% CI 0.69 to 1.41). In the cost model, raltitrexed plus cisplatin cost £13,454 per quality-adjusted life year gained compared with cisplatin alone, and £27,360 compared with active symptom control. Pemetrexed plus cisplatin cost more and gave marginally fewer quality-adjusted life years, so raltitrexed plus cisplatin outperformed it in the model. The authors concluded that raltitrexed plus cisplatin is a cost-effective first-line treatment. They noted that the trials appeared to differ somewhat in the mix of mesothelioma tissue types (histology), and that the model left out later lines of treatment.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Adjusted indirect comparison of two randomised trials plus a cost-effectiveness (partitioned survival) model; health-economic analysis
• Who was studied: Modelled patients with malignant pleural mesothelioma receiving first-line treatment, analysed from a UK National Health Service and personal social services perspective over a 5-year lifetime horizon (2009 costs). Baseline progression and survival came from individual patient data in the cisplatin arm of the EORTC 08983 trial.
• Exposure: Chemotherapy regimens, not asbestos: raltitrexed plus cisplatin (from EORTC 08983), pemetrexed plus cisplatin (from EMPHACIS), cisplatin alone, and active symptom control
• Main results:
  • The updated literature search found no additional eligible trials, so only EORTC 08983 and EMPHACIS were used
  • Overall response, raltitrexed plus cisplatin vs. pemetrexed plus cisplatin: odds ratio 0.56 (95% CI 0.24 to 1.30), a non-statistically significant trend in favour of pemetrexed
  • Raltitrexed plus cisplatin vs. pemetrexed plus cisplatin: hazard ratio 1.15 (95% CI 0.82 to 1.61) for progression-free survival and 0.99 (95% CI 0.69 to 1.41) for overall survival
  • Incremental cost over active symptom control: £2930 for cisplatin, £5764 for raltitrexed plus cisplatin, £10,706 for pemetrexed plus cisplatin
  • QALY gain over active symptom control: 0.20 for pemetrexed plus cisplatin and 0.21 for raltitrexed plus cisplatin
  • With active symptom control excluded, raltitrexed plus cisplatin vs. cisplatin: £13,454 per QALY and £9510 per life year
  • With active symptom control included, raltitrexed plus cisplatin vs. active symptom control: £27,360 per QALY and £19,340 per life year
  • Pemetrexed plus cisplatin was dominated by raltitrexed plus cisplatin (marginally fewer QALYs and life years at higher total cost)
  • In the fully supplemented and progression-based quality-of-life scenarios, pemetrexed plus cisplatin became most effective, but its cost per QALY over raltitrexed plus cisplatin exceeded £300,000
  • Results were most sensitive to the assumed efficacy of cisplatin vs. active symptom control and to a 29-month time horizon: £17,126 and £44,087 per QALY for raltitrexed plus cisplatin vs. cisplatin
  • Probabilistic analysis, active symptom control excluded: raltitrexed plus cisplatin cost-effective with probability 74% to 82% at £20,000 to £30,000 per QALY
  • Probabilistic analysis, active symptom control included: raltitrexed plus cisplatin remained most likely to be cost-effective, but with probability 31% to 52%
• The authors' conclusion: The authors concluded that raltitrexed plus cisplatin is a cost-effective first-line treatment for malignant pleural mesothelioma, and that this held across a number of sensitivity analyses
• Limitations the authors state:
  • The two trials appear to differ somewhat in their mix of histology, and performance status was measured differently, which could bias the indirect comparison
  • Response and progression-free survival are unreliable measures in mesothelioma because radiographic assessment is difficult
  • The base case assumed cisplatin and active symptom control are equally effective
  • Costs were based on trial doses and cycles, which may differ from practice
  • Costs and outcomes of second and later lines of chemotherapy were not included

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Raltitrexed, Cisplatin, Pemetrexed (Alimta), Pleural Mesothelioma, Performance Status, Chemotherapy, Overall Survival.

Related studies

• Cost-effectiveness analysis of additional bevacizumab to pemetrexed plus cisplatin for malignant pleural mesothelioma based on the MAPS trial — M. Zhan, H. Zheng, et al. (2017)
• In Australia, patients and government at odds over mesothelioma treatment costs — V. Burkitt (2007)
• A feasibility study of induction pemetrexed plus cisplatin followed by pleurectomy/decortication aimed at macroscopic complete resection for malignant pleural mesothelioma — M. Shimokawa, S. Hasegawa, et al. (2013)
• Comparison of cisplatin plus pemetrexed and cisplatin plus gemcitabine for the treatment of malignant pleural mesothelioma in Japanese patients — T. Shukuya, T. Takahashi, et al. (2014)
• Combination raltitrexed (Tomudex(R))-oxaliplatin: a step forward in the struggle against mesothelioma? The Institut Gustave Roussy experience with chemotherapy and chemo-immunotherapy in mesothelioma — K. Fizazi, R. Caliandro, et al. (2000)
• Raltitrexed in mesothelioma — V.F. Surmont, J.P. van Meerbeeck (2011)

Browse more research in Lung Cancer, or return to medical research.