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        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Objectivo&#58;</span> Avaliar o custo-efectividade de erlotinib na segunda ou terceira linha do tratamento do cancro do pulm&#227;o de n&#227;o pequenas c&#233;lulas &#40;CPNPC&#41; avan&#231;ado ou metastizado <span class="elsevierStyleItalic">versus</span> docetaxel&#44; pemetrexedo ou tratamento de suporte&#46;</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Material e m&#233;todos&#58;</span> An&#225;lises de minimiza&#231;&#227;o de custos e custo-utilidade&#46; Horizonte temporal&#58; dois anos&#46; Perspectiva do Sistema Nacional de Sa&#250;de &#40;SNS&#41; portugu&#234;s&#46; Sobreviv&#234;ncia e tempo at&#233; progress&#227;o obtidos a partir de tr&#234;s ensaios cl&#237;nicos&#46; An&#225;lise-base inclui doentes com CPNPC avan&#231;ado ou metastizado em segunda ou terceira linhas&#46; Anos de vida ajustados pela qualidade &#40;ou QALY&#41; obtidos a partir de estudo no Reino Unido&#46; Consumo de recursos estimado por painel de peritos portugueses&#46; Inclu&#237;ram-se apenas custos directos&#44; obtidos a partir de fontes oficiais &#40;pre&#231;os actualizados para 2008&#41;&#46; Taxa de actualiza&#231;&#227;o anual&#58; 5&#37;&#46; An&#225;lises de sensibilidade&#58; diferentes subpopula&#231;&#245;es&#44; horizonte temporal a tr&#234;s anos e an&#225;lise probabil&#237;stica&#46;</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Resultados&#58;</span> O custo total&#47;doente foi menor com erlotinib &#40;26 478&#8364;&#41; <span class="elsevierStyleItalic">versus</span> docetaxel &#40;29 262&#8364;&#41; ou pemetrexedo &#40;32 762&#8364;&#41; e superior <span class="elsevierStyleItalic">versus</span> tratamento de suporte &#40;16 112&#8364;&#41;&#46; Obtiveram-se QALY&#47;doente mais elevados com erlotinib &#40;0&#44;250&#41; <span class="elsevierStyleItalic">versus</span> docetaxel &#40;0&#44;225&#41;&#44; pemetrexedo &#40;0&#44;241&#41; ou tratamento de suporte &#40;0&#44;186&#41;&#46; Assim&#44; o erlotinib mostrou-se &#8220;dominante&#8221; em segunda ou terceira linhas <span class="elsevierStyleItalic">versus</span> docetaxel e pemetrexedo&#46; A an&#225;lise de sensibilidade comprova a robustez dos resultados&#46;</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclus&#245;es&#58;</span> A substitui&#231;&#227;o de docetaxel ou pemetrexedo por erlotinib poderia contribuir para uma redu&#231;&#227;o anual dos gastos do SNS que se estima &#40;taxas substitui&#231;&#227;o&#58; 5&#37;-65&#37;&#41; com uma varia&#231;&#227;o entre 135 046&#8364;-1 755 602&#8364; e entre 291 801&#8364;-3 793 409&#8364;&#44; respectivamente&#44; e com ganho em termos de QALY&#46;</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2008&#59; XIV &#40;6&#41;&#58; 803-827</span></p></span>"
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        "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Aim&#58;</span> Evaluate costs and benefits of erlotinib as 2<span class="elsevierStyleSup">nd</span> or 3<span class="elsevierStyleSup">rd</span> line treatment of advanced or metastatic nonsmall cell lung cancer &#40;NSCLC&#41; <span class="elsevierStyleItalic">versus</span> docetaxel&#44; pemetrexed and best supportive care&#46;</p><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Materials and methods&#58;</span> Cost-minimisation and cost-utility analysis were performed&#46; Time horizon of two years&#46; Portuguese National Health System &#40;NHS&#41; perspective was applied&#46; Survival and time to progression were obtained from three clinical trials&#46; Base-case analysis&#58; 2<span class="elsevierStyleSup">nd</span> or 3<span class="elsevierStyleSup">rd</span> line patients with advanced or metastatic NSCLC&#46; Quality Adjusted Life Years &#40;QALYs&#41; were obtained from a UK study&#46; Resource consumption was estimated by a Portuguese panel of experts&#46; Costs were calculated according to official Portuguese databases &#40;updated to 2008&#41;&#46; Only direct health costs were applied&#46; Annual discount rate&#58; 5&#37;&#46; Sensitivity analysis included different subpopulations&#44; a three year time horizon and a probabilistic analysis&#46;</p><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Results&#58;</span> The cost per patient was lower with erlotinib &#40;&#8364;26 478&#41; than docetaxel &#40;&#8364;29 262&#41; or pemetrexed &#40;&#8364;32 762&#41; and higher than best supportive care &#40;&#8364;16 112&#41;&#46; QALYs per patient were higher with erlotinib &#40;0&#46;250&#41; than docetaxel &#40;0&#46;225&#41;&#44; pemetrexed &#40;0&#46;241&#41; or best supportive care &#40;0&#46;186&#41;&#46; Erlotinib was dominant in the cost-utility analysis&#44; with a lower cost and a higher efficacy than docetaxel and pemetrexed&#46; The sensitivity analysis confirmed the robustness of the base-case analysis results&#46;</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusions&#58;</span> The use of erlotinib instead of docetaxel or pemetrexed could contribute to annual savings for the NHS &#40;substitution rates&#58; 5&#37;-65&#37;&#41; ranging from &#8364;135 046-&#8364;1 755 602 &#40;docetaxel replacement&#41; and &#8364;291 801-&#8364;3 793 409 &#40;pemetrexed replacement&#41;&#44; with a gain in terms of QALYs&#46;</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2008&#59; XIV &#40;6&#41;&#58; 803-827</span></p></span>"
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Vol. 14. Issue 6.
Pages 803-827 (November - December 2008)
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Vol. 14. Issue 6.
Pages 803-827 (November - December 2008)
Artigo Original/Original Article
Open Access
Avaliação económica do erlotinib, docetaxel, pemetrexedo e tratamento de suporte no tratamento de segunda ou terceira linhas de doentes com cancro do pulmão de não pequenas células
An economic analysis of erlotinib, docetaxel, pemetrexed and best supportive care as second or third line treatment of non-small cell lung cancer
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A. Araújo1, B. Parente2, R. Sotto-Mayor3, E. Teixeira4, T. Almodôvar5, F. Barata6, H. Queiroga7, C. Pereira8, H. Pereira9, F. Negreiro10, C. Silva11
1 Coordenador da Clínica de Patologia do Pulmão, Serviço de Oncologia Médica, Instituto Português de Oncologia Francisco Gentil – Centro do Porto, Portugal / Francisco Gentil Portuguese Oncology Institute, Centro do Porto, Lung Pathology Clinic Coordinator, Medical Oncology Unit, Porto, Portugal
2 Directora do Serviço de Pneumologia, Serviço de Pneumologia, Centro Hospitalar de V. N. Gaia, Portugal / Centro Hospitalar de V. N. Gaia, Head, Pulmonology Unit, Pulmonology Unit, V. N. Gaia, Portugal
3 Chefe de Serviço de Pneumologia, Serviço de Pneumologia do Hospital de Santa Maria, CHLN, Lisboa, Portugal / Head, Pulmonology Unit, Pulmonology Unit, Hospital de Santa Maria, CHLN, Lisbon, Portugal
4 Assistente Graduada de Pneumologia, Serviço de Pneumologia, Hospital de Santa Maria, Lisboa, Portugal / Hospital de Santa Maria, Consultant, Pulmonology specialist, Pulmonology Unit, Lisbon, Portugal
5 Serviço de Pneumologia; Instituto Português de Oncologia de Francisco Gentil, Lisboa, Portugal / Pulmonology Unit, Francisco Gentil Portuguese Oncology Institute, Lisbon, Portugal
6 Responsável de Pneumologia Oncológica, Centro Hospitalar de Coimbra, Portugal / Head, Pulmonary Oncology, Centro Hospitalar de Coimbra, Portugal
7 Coordenador da Consulta de Pneumologia Oncológica, Hospital de S. João, Porto; Portugal / Pulmonary Oncology Appointment Coordinator, Hospital de S. João, Porto, Portugal
8 Pharmacoeconomic Manager, Departamento de Market Access & Health Economics, Roche Farmacêutica Química, Lda.; Portugal / Pharmacoeconomic Manager, Market Access & Health Economics Unit, Roche Farmacêutica Química, Lda., Portugal
9 Medical Manager Oncologia Pulmão, Roche Farmacêutica Química, Lda., Portugal / Medical Manager, Pulmonary Oncology, Roche Farmacêutica Química, Lda., Portugal
10 Bioestatista, Eurotrials - Consultores Científicos, Lisboa, Portugal / Biostatistician, Eurotrials - Consultores Científicos, Lisbon, Portugal
11 Bioestatista Sénior, Eurotrials - Consultores Científicos, Lisboa; Portugal / Senior Biostatistician, Eurotrials - Consultores Científicos, Lisbon, Portugal
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Resumo

Objectivo: Avaliar o custo-efectividade de erlotinib na segunda ou terceira linha do tratamento do cancro do pulmão de não pequenas células (CPNPC) avançado ou metastizado versus docetaxel, pemetrexedo ou tratamento de suporte.

Material e métodos: Análises de minimização de custos e custo-utilidade. Horizonte temporal: dois anos. Perspectiva do Sistema Nacional de Saúde (SNS) português. Sobrevivência e tempo até progressão obtidos a partir de três ensaios clínicos. Análise-base inclui doentes com CPNPC avançado ou metastizado em segunda ou terceira linhas. Anos de vida ajustados pela qualidade (ou QALY) obtidos a partir de estudo no Reino Unido. Consumo de recursos estimado por painel de peritos portugueses. Incluíram-se apenas custos directos, obtidos a partir de fontes oficiais (preços actualizados para 2008). Taxa de actualização anual: 5%. Análises de sensibilidade: diferentes subpopulações, horizonte temporal a três anos e análise probabilística.

Resultados: O custo total/doente foi menor com erlotinib (26 478€) versus docetaxel (29 262€) ou pemetrexedo (32 762€) e superior versus tratamento de suporte (16 112€). Obtiveram-se QALY/doente mais elevados com erlotinib (0,250) versus docetaxel (0,225), pemetrexedo (0,241) ou tratamento de suporte (0,186). Assim, o erlotinib mostrou-se “dominante” em segunda ou terceira linhas versus docetaxel e pemetrexedo. A análise de sensibilidade comprova a robustez dos resultados.

Conclusões: A substituição de docetaxel ou pemetrexedo por erlotinib poderia contribuir para uma redução anual dos gastos do SNS que se estima (taxas substituição: 5%-65%) com uma variação entre 135 046€-1 755 602€ e entre 291 801€-3 793 409€, respectivamente, e com ganho em termos de QALY.

Rev Port Pneumol 2008; XIV (6): 803-827

Palavras-chave:
Cancro do pulmão de não pequenas células
económico
Portugal
utilidade
custo-efectividade
Abstract

Aim: Evaluate costs and benefits of erlotinib as 2nd or 3rd line treatment of advanced or metastatic nonsmall cell lung cancer (NSCLC) versus docetaxel, pemetrexed and best supportive care.

Materials and methods: Cost-minimisation and cost-utility analysis were performed. Time horizon of two years. Portuguese National Health System (NHS) perspective was applied. Survival and time to progression were obtained from three clinical trials. Base-case analysis: 2nd or 3rd line patients with advanced or metastatic NSCLC. Quality Adjusted Life Years (QALYs) were obtained from a UK study. Resource consumption was estimated by a Portuguese panel of experts. Costs were calculated according to official Portuguese databases (updated to 2008). Only direct health costs were applied. Annual discount rate: 5%. Sensitivity analysis included different subpopulations, a three year time horizon and a probabilistic analysis.

Results: The cost per patient was lower with erlotinib (€26 478) than docetaxel (€29 262) or pemetrexed (€32 762) and higher than best supportive care (€16 112). QALYs per patient were higher with erlotinib (0.250) than docetaxel (0.225), pemetrexed (0.241) or best supportive care (0.186). Erlotinib was dominant in the cost-utility analysis, with a lower cost and a higher efficacy than docetaxel and pemetrexed. The sensitivity analysis confirmed the robustness of the base-case analysis results.

Conclusions: The use of erlotinib instead of docetaxel or pemetrexed could contribute to annual savings for the NHS (substitution rates: 5%-65%) ranging from €135 046-€1 755 602 (docetaxel replacement) and €291 801-€3 793 409 (pemetrexed replacement), with a gain in terms of QALYs.

Rev Port Pneumol 2008; XIV (6): 803-827

Key-words:
Non-small cell lung cancer
economics
Portugal
utility
cost-effectiveness
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