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C. Barrios



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    P1.11 - Poster Session 1 - NSCLC Novel Therapies (ID 208)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P1.11-045 - Cost-Effectiveness of Carboplatin and Pemetrexed Versus Single Agent Pemetrexed in Patients with Advanced NSCLC and Performance Status of 2 (PS2) (ID 2993)

      09:30 - 09:30  |  Author(s): C. Barrios

      • Abstract

      Background
      Health care expenditures have increased dramatically over the past 20 years. Particularly in oncology new technologies may be accompanied by higher costs but a mild health gain. As part of decision-making process, not only effective, but economic value evidence is mandatory in many developed countries. We have recently shown that the combination of carboplatin and pemetrexed improves survival in a dedicated ECOG PS2 population when compared to pemetrexed alone (Zukin et al. J Clin Oncol 2013). Because combination chemotherapy tends to increase toxicity and costs, a cost-effective analysis was performed in that PS2 dedicated trial.

      Methods
      Clinical data and resource consumptions were obtained from the multicenter phase III randomized trial which tested carboplatin and pemetrexed vs. pemetrexed alone in 205 patients with advanced NSCLC and PS 2. Direct costs were estimated based on Brazilian public health care system. Life time was divided into stable disease stage, progression stage and death. Utilities for each stage were taken from the literature. One-way sensitivity analysis and non-parametric bootstrapping approach were performed to explore the uncertainties regarding the results.

      Results
      Combination chemotherapy demonstrated a gain in 0.22 life years (LY) and 0.15 quality-adjusted life year (QALY) compared to single therapy at an additional cost of $1,667.28 (in 2012 USD). The incremental cost-effectiveness ratio (ICER) was $7,436.79/LY and $10,949.88/QALY. Estimates of ICER were more sensitive to change by the influence of stable disease utility and pemetrexed cost. The probability of being cost-effective at a threshold of $36,000 (3 times Brazilian GDP per capita) per additional QALY was > 99%.

      Conclusion
      Adding carboplatin to pemetrexed therapy for advanced NSCLC patients with PS2 status is cost-effective when compared to pemetrexed alone. To the best of our knowledge this is the first report on cost-effectiveness in a dedicated NSCLC PS2 population. This finding adds up to the efficacy data favoring the combination arm and may support health care policies in that subpopulation. This analysis is particularly relevant for countries with limited health care resources.

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    P3.22 - Poster Session 3 - Epidemiology, Etiology (ID 168)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      P3.22-002 - Lung Cancer: histology, gender and age changes over the past 25 years in Brazil (ID 984)

      09:30 - 09:30  |  Author(s): C. Barrios

      • Abstract

      Background
      Lung cancer is the leading cause of cancer related death worldwide when considering both genders. The great effort to reduce smoking and introduce of cigarette has changed lung cancer epidemiology. In developed countries the increasing incidence of adenocarcinoma and decrease of squamous cell carcinoma are well known. Other characteristic reported is the rising number of women with the disease. Better understanding of current lung cancer epidemiology is necessary for the appropriate design of public health strategies for prevention, diagnosis and treatment.

      Methods
      Retrospective analysis of all patients with non-small cell lung cancer (NSCLC) treated with lung resection between 1986 and 2010 in a University Hospital of South Brazil. Analysis was divided in three periods 1986-1990, 1991-2000 and 2001-2010. Histological diagnosis was performed by the same pathology group and all staging was updated according to the new IASLC 7th edition. All analyses were performed using the SAS program version 13.

      Results
      We studied 817 patients who underwent lung resection for NSCLC from 1986 to 2010. 70.0% were males, average age 61.4 years, 44.2% squamous cell carcinoma and 40.0% adenocarcinoma, 26.7% stage IIIA. The female proportion increased from 22.0% in the first period to 36.0% in the last decade. Mean age at surgery treatment was 52.7 years for women and 57.3 for men in the first period, and 60.1 for woman and 63.9 for men in the last period (p<0.001). The proportion of squamous cell changed from 49.1% initially to 38.7% on the last period (p=0.017). In comparison, the adenocarcinoma prevalence increased from 35.4%, 39.6% and most recently 41.21%. Of the total NSCLC patients, females with adenocarcinoma represented 9.4% in the first period, 12.5% in the second and 16.8% in last period. Patients with stage IIIA represented 27.9% in the last decade. Type of surgery was predominantly lobectomy. Pneumonectomy was the surgical procedure in 21.9%, 18.8% and 16.8% of cases in each period respectively (p<0.03).

      Conclusion
      In this cohort of patients in south Brazil, gender analysis shows that rates of lung cancer in females is raising over the last three decades but has not surpassed men rates. The proportion of adenocarcinoma in females has increased. The significant decrease of pneumonectomy rates probably reflects changes on surgical management techniques and indication. The mean average age for patients undergoing surgical treatment has increased for both men and women. These findings are in accordance with the data of developed countries.