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

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).


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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.

Item Type: Article
Digital Object Identifier (DOI): doi:10.1016/j.ctrv.2010.07.005
ISSNs: 0305-7372 (print)
1532-1967 (electronic)
Subjects: R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
R Medicine > RS Pharmacy and materia medica
Divisions : University Structure - Pre August 2011 > School of Medicine > Cancer Sciences
ePrint ID: 168281
Accepted Date and Publication Date:
August 2010Published
Date Deposited: 26 Nov 2010 12:43
Last Modified: 31 Mar 2016 13:30

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