A large randomized clinical trial in advanced, previously untreated, non-small cell lung cancer (NSCLC) patients revealed better response rates and better tolerance for paclitaxel+cisplatin (TAXCIS) compared to teniposide+cisplatin (TENCIS). Since economic evidence is receiving increasing attention in health care, we conducted;an economic evaluation based on the trial results in The Netherlands, Belgium, France and Spain. The evaluation was based on (i) differences in drug costs, (ii) differences in chemotherapy administration and (iii) the economic consequences of significantly different clinical outcomes in the trial: anemia, thrombocytopenia, neutropenia, neuropathy and arthralgia/myalgia. Data regarding medical resource utilization were obtained from clinician interviews using a Delphi technique and validated by patient charts analysis. Differences in medical management occurred across countries, but TAXCIS was cost-additive in all countries, i.e. the extra cost of chemotherapy was only partially compensated by savings in medical resource use, resulting in a net cost per patient of US$2311. In the trial, TAXCIS therapy produced a 37% response rate compared to 26% for TENCIS. The cast per extra responder for TAXCIS is on average US$21011, which is comparable to the cost per responder obtained with TENCIS (US$27266). Thus, the cost-effectiveness of TAXCIS, expressed in cost per responder, is similar to the cost-effectiveness obtained with TENCIS. [(C) 1999 Lippincott Williams & Wilkins.].
