Lung Cancer 75 (2012) 261–267 Contents lists available at ScienceDirect Lung Cancer j our na l ho me p age: www.elsevier.com/locate/lungcan Raltitrexed plus cisplatin is cost-effective compared with pemetrexed plus cisplatin in patients with malignant pleural mesothelioma Beth Woods a,∗ , Noman Paracha a , David A. Scott a , Nicholas Thatcher b,1 a Oxford Outcomes, Oxford, UK b Christie Hospital NHS Trust, Manchester, UK a r t i c l e i n f o Article history: Received 20 April 2011 Received in revised form 8 July 2011 Accepted 16 July 2011 Keywords: Cost-effectiveness Indirect comparison Mesothelioma Chemotherapy a b s t r a c t Introduction: The National Institute for Health and Clinical Excellence (NICE) has previously recommended pemetrexed plus cisplatin for the treatment of patients with advanced malignant pleural mesothelioma (MPM) and WHO performance status 0–1. Subsequent to this appraisal, randomised controlled trial (RCT) data for raltitrexed plus cisplatin and comparing chemotherapy to active symptom control (ASC) has become available, allowing a more complete analysis of the comparative efficacy and cost-effectiveness of first-line chemotherapy in MPM. Methods: An adjusted indirect comparison is used to estimate the relative efficacy of raltitrexed plus cisplatin and pemetrexed plus cisplatin. A cost-effectiveness model is used to assess the lifetime costs and health outcomes associated with these comparators and ASC. Patient level data from the EORTC 08983 trial are used to estimate baseline progression and survival rates. Relative treatment effects are taken from RCTs; cost and utility data from the literature. Results: Raltitrexed plus cisplatin and pemetrexed plus cisplatin were not found to be statistically sig- nificantly different with respect to overall response, progression free survival or overall survival. The cost-effectiveness analysis found raltitrexed plus cisplatin to be cost-effective at a cost per quality adjusted life year of £13,454 compared to cisplatin and £27,360 compared to ASC. Pemetrexed plus cis- platin is dominated by raltitrexed plus cisplatin as the raltitrexed combination offers marginally higher quality adjusted life years (QALYs) and life years (LYs) at a substantially lower total cost. Conclusion: Raltitrexed plus cisplatin is a cost-effective first-line treatment for MPM. This conclusion was maintained across a number of sensitivity analyses. © 2011 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Malignant pleural mesothelioma (MPM) is a locally invasive and rapidly fatal malignancy caused in the majority of cases by asbestos exposure. Mesothelioma deaths in the UK have increased from 153 in 1968 to 2156 in 2007 [1]; recent projections suggest that mesothelioma deaths in UK males will peak at 2038 in 2016 [2]. Curative surgical resection is possible in a minority of MPM patients, however for unresectable disease, chemotherapy is used to improve disease related symptoms and survival. Both peme- trexed and raltitrexed in combination with cisplatin have been shown to be effective first-line treatments in patients with unre- sectable disease [3]. ∗ Corresponding author at: Oxford Outcomes, Seacourt Tower, West Way, Botley, Oxford, OX2 0JJ, UK. Tel.: +44 1865 324 930; fax: +44 01865 324 931. E-mail address: beth.woods@oxfordoutcomes.com (B. Woods). 1 Department of Medical Oncology, Christie Hospital NHS Trust, Wilmslow Road, Manchester, M20 4BX. Pemetrexed-based first-line treatment has been appraised by the National Institute for Health and Clinical Excellence (NICE) in the UK. NICE found pemetrexed plus cisplatin to offer an effective treatment option in this patient population, however due to con- cerns regarding the cost-effectiveness of pemetrexed treatment, it was only recommended for patients with advanced disease (stage III/IV) and a World Health Organization (WHO) performance status of 0 or 1 [4]. The NICE appraisal of pemetrexed identified a number of limitations to the existing evidence base available to compare alter- native first-line treatments. Firstly, the appraisal did not include raltitrexed as a comparator as phase III trial data for raltitrexed was only starting to become available at the time the pemetrexed appraisal was scoped [5]. Secondly, at the time of the appraisal no randomised controlled trial (RCT) evidence comparing chemother- apy to active symptom control (ASC) was available. In particular, the MS-01 trial [6] comparing vinorelbine; mitomycin C plus vin- blastine plus cisplatin (MVP); and ASC had not yet completed [7]. We present the results of an indirect comparison of pemetrexed and raltitrexed and a cost-effectiveness analysis comparing these agents to ASC. 0169-5002/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.lungcan.2011.07.011