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Topotecan for relapsed small cell lung cancer: a systematic review and economic evaluation

Topotecan for relapsed small cell lung cancer: a systematic review and economic evaluation
Topotecan for relapsed small cell lung cancer: a systematic review and economic evaluation
Background: Topotecan is a relatively new drug for use as a second-line treatment in patients with relapsed small cell lung cancer (SCLC). We performed a systematic review and economic evaluation of topotecan, and consider it here in relation to the NICE end of life criteria.

Methods: Seventeen bibliographic databases (including Cochrane library, Medline and Embase) were searched from 1990 to February 2009, and experts and manufacturers were consulted, to identify relevant randomised controlled trials (RCTs) which were selected according to prospectively defined criteria. An economic evaluation was undertaken to assess cost effectiveness compared with best supportive care (BSC) in the UK.

Results: Five RCTs were included. The clinical evidence indicates a statistically significant benefit of oral topotecan plus BSC compared to BSC alone for overall survival. Intravenous topotecan was similar in efficacy to both oral topotecan and CAV (cyclophosphamide, doxorubicin and vincristine). In the survival model, oral topotecan plus BSC was associated with an average gain in life expectancy of approximately 4months, resulting in a gain of 0.183 quality-adjusted life years (QALYs). At an incremental cost of approximately pound6200 the incremental cost effectiveness ratio (ICER) is pound33,851 per QALY gained.

Conclusions: Compared with BSC alone, oral topotecan for patients with relapsed SCLC was associated with improved health outcomes but at increased cost. The ICER is at the upper extreme of the range conventionally regarded as cost effective from an NHS decision making perspective. However, this treatment may fall under supplementary guidance for life extending, end of life treatments.
0305-7372
242-249
Hartwell, Debbie
e6a0eaa0-956d-45fb-9b7d-03ca1af3334c
Jones, Jeremy
270b303b-6bad-4be7-8ea0-63d0e8015c91
Loveman, Emma
06ff1bf1-0189-4330-b22d-f5a917e9871d
Harris, Petra
0e15de29-ece4-43e6-9861-4e20bcee5acd
Clegg, Andrew J.
838091f5-39df-4dbe-a369-675b26f2301b
Bird, Alex
a6c30c9f-7730-4782-944e-8f282665e087
Hartwell, Debbie
e6a0eaa0-956d-45fb-9b7d-03ca1af3334c
Jones, Jeremy
270b303b-6bad-4be7-8ea0-63d0e8015c91
Loveman, Emma
06ff1bf1-0189-4330-b22d-f5a917e9871d
Harris, Petra
0e15de29-ece4-43e6-9861-4e20bcee5acd
Clegg, Andrew J.
838091f5-39df-4dbe-a369-675b26f2301b
Bird, Alex
a6c30c9f-7730-4782-944e-8f282665e087

Hartwell, Debbie, Jones, Jeremy, Loveman, Emma, Harris, Petra, Clegg, Andrew J. and Bird, Alex (2010) Topotecan for relapsed small cell lung cancer: a systematic review and economic evaluation. Cancer Treatment Reviews, 37 (3), 242-249. (doi:10.1016/j.ctrv.2010.07.005). (PMID:20709456)

Record type: Article

Abstract

Background: Topotecan is a relatively new drug for use as a second-line treatment in patients with relapsed small cell lung cancer (SCLC). We performed a systematic review and economic evaluation of topotecan, and consider it here in relation to the NICE end of life criteria.

Methods: Seventeen bibliographic databases (including Cochrane library, Medline and Embase) were searched from 1990 to February 2009, and experts and manufacturers were consulted, to identify relevant randomised controlled trials (RCTs) which were selected according to prospectively defined criteria. An economic evaluation was undertaken to assess cost effectiveness compared with best supportive care (BSC) in the UK.

Results: Five RCTs were included. The clinical evidence indicates a statistically significant benefit of oral topotecan plus BSC compared to BSC alone for overall survival. Intravenous topotecan was similar in efficacy to both oral topotecan and CAV (cyclophosphamide, doxorubicin and vincristine). In the survival model, oral topotecan plus BSC was associated with an average gain in life expectancy of approximately 4months, resulting in a gain of 0.183 quality-adjusted life years (QALYs). At an incremental cost of approximately pound6200 the incremental cost effectiveness ratio (ICER) is pound33,851 per QALY gained.

Conclusions: Compared with BSC alone, oral topotecan for patients with relapsed SCLC was associated with improved health outcomes but at increased cost. The ICER is at the upper extreme of the range conventionally regarded as cost effective from an NHS decision making perspective. However, this treatment may fall under supplementary guidance for life extending, end of life treatments.

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Published date: August 2010

Identifiers

Local EPrints ID: 168281
URI: http://eprints.soton.ac.uk/id/eprint/168281
ISSN: 0305-7372
PURE UUID: 41327f58-650d-4cf1-9739-5fd5a4b320f1

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Date deposited: 26 Nov 2010 12:43
Last modified: 14 Mar 2024 02:17

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Contributors

Author: Debbie Hartwell
Author: Jeremy Jones
Author: Emma Loveman
Author: Petra Harris
Author: Andrew J. Clegg
Author: Alex Bird

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