Medical resource utilization (MRU) and costs associated with paclitaxel poliglumex (PPX) compared to gemcitabine (Gem) or vinorelbine (Vin) in non-small cell lung cancer (NSCLC) patients

Abstract

18172 Background: NSCLC accounts for 80% of lung cancer cases and is commonly treated with taxanes. PPX is a phase III, biologically-enhanced, investigational, chemotherapeutic for treatment of NSCLC that links paclitaxel to a biodegradable polyglutamate polymer that potentially spares normal tissue exposure to chemotherapy toxicities. Methods: MRU data were collected as part of a multinational, randomized trial that compared PPX (n=191) to Gem or Vin (n=190) in chemotherapy-naïve advanced NSCLC patients with a performance status of 2. MRU and costs associated with chemotherapy administration and non-protocol-driven care were compared over the study period. Costs (2005 U.S. dollars) were assigned from a U.S. payer perspective. Results: Patient demographics were similar (p>0.05) between groups (mean age: 62 yrs, 72% male, 89% Caucasian). PPX had slightly longer median survival (220 vs. 198; p=0.686) with significantly fewer adverse events (all grades; 2.0 vs. 3.0; p=0.011) and significantly more chemotherapy cycles (3.4 vs. 3.9; p=0.007), per subject. Additionally, PPX had fewer outpatient visits (0.6 vs. 1.7; p<0.001), diagnostic tests (0.6 vs. 1.9; p<0.001), and days on non-chemotherapy medications (64.4 vs. 91.2; p<0.001), per subject. There was no significant difference in number of hospitalizations (0.04 in both groups; p=0.786), length of stay among those hospitalized (8.4 days PPX vs. 6.1 days Gem or Vin; p=0.301), or procedures (0.02 PPX vs. 0.04 Gem or Vin; p=0.238), per subject. Average costs per subject were significantly lower in PPX for outpatient visits ($34 vs. $78; p=0.014), non-chemotherapy medications ($717 vs. $911; p<0.001), and chemotherapy administration ($1,557 vs. $3,601; p<0.001) and similar for inpatient stays ($210 PPX vs. $244 Gen or Vin; p=0.794). Conclusions: This analysis suggests that, in addition to providing a clinical benefit of fewer adverse events, PPX results in reduced MRU and associated costs compared to Gem or Vin in treating NSCLC. These cost savings can be weighed against the cost of PPX and may provide a pharmacoeconomic advantage. Further research is warranted to confirm these results in routine clinical practice. [Table: see text]