CORRESPONDENCE

RESPONSE: Re: Economic Analysis of Vinorelbine Plus Cisplatin Versus Paclitaxel Plus Carboplatin for Advanced Non-Small-Cell Lung Cancer

Scott Ramsey

Correspondence to: Scott D. Ramsey, M.D., Ph.D., Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. North, MP-900, Box 19024, Seattle, WA 98109–1024 (e-mail: sramsey{at}fhcrc.org).

Dr. Malayeri expresses concern that because our cost–effectiveness study was conducted alongside a clinical trial, the external validity of the findings is potentially in question. As with findings from any clinical study, we would caution readers against extrapolating the economic findings to patients, treatments, or settings that do not resemble those found in the trial. This applies to advanced lung cancer patients with poor performance status. Of note, the Eastern Cooperative Oncology Group trial cited by Dr. Malayeri found that persons with poor performance status randomly assigned to the carboplatin plus paclitaxel arm of the trial experienced less toxicity but also had poorer survival compared with the other regimens studied (1). Use of platinum-based combination chemotherapy regimens in patients with advanced non-small-cell lung cancer and poor performance status is not recommended and is thus beyond the scope of our analysis (2). Dr. Malayeri's assertion that our study is biased because we did not account for the higher rate of hospitalizations for those treated with cisplatin plus vinorelbine is incorrect. In our paper, we note that those treated with cisplatin plus vinorelbine incurred more than twice as many days in a hospital nonintensive care unit, predominantly during the induction phase of treatment. After accounting for these hospital costs (as well as all other costs related to cancer care), we determined that the overall lifetime cost for those treated with cisplatin plus vinorelbine was far less than the cost for those treated with carboplatin plus paclitaxel. We feel that decision makers can use our results, confident that they are free from bias, while retaining the usual cautions about extrapolating the results from controlled clinical trials to other settings.

REFERENCES

1 Sweeney CJ, Zhu J, Sandler AB, Schiller J, Belani CP, Langer C, et al. Outcome of patients with a performance status of 2 in Eastern Cooperative Oncology Group Study E1594: a Phase II trial in patients with metastatic non-small-cell lung carcinoma. Cancer 2001;92:2639–47.[Medline]

2 Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Krook J, et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med 2002;346:92–8.[Abstract/Free Full Text]



             
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