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Economic Analysis of NCIC CTG JBR.10: A Randomized Trial of Adjuvant Vinorelbine Plus Cisplatin Compared With Observation in Early Stage Non–Small-Cell Lung Cancer—A Report of the Working Group on Economic Analysis, and the Lung Disease Site Group, National Cancer Institute of Canada Clinical Trials Group

Raymond Ng, Baktiar Hasan, Nicole Mittmann, Marie Florescu, Frances A. Shepherd, Keyue Ding, Charles Andrew Butts, Yvon Cormier, Gail Darling, Glenwood D. Goss, Richard Inculet, Lesley Seymour, Timothy L. Winton, William K. Evans, Natasha B. Leighl

From the Department of Hematology and Medical Oncology, Princess Margaret Hospital; Health Outcomes and Pharmacoeconomic Evaluation Research Centre, Sunnybrook Health Sciences Centre; Division of Thoracic Surgery, Toronto General Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Division of Medical Oncology, Cross Cancer Institute, Edmonton, Alberta; Département de pneumologie, Hôpital Laval, Québec City, Québec; Ottawa Hospital Regional Cancer Centre, Ottawa; Division of Thoracic Surgery, London Health Sciences Centre, London; and the Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Ontario, Canada

Address reprint requests to Natasha Leighl, MD, MMSc, FRCPC, Princess Margaret Hospital, Suite 5-105, 610 University Ave, Toronto, Ontario, Canada M5G 2M9; e-mail: Natasha.Leighl{at}uhn.on.ca

Purpose: National Cancer Institute of Canada Clinical Trials Group JBR.10 study is among the landmark trials that have established third generation platinum-based adjuvant chemotherapy as the standard of care after resection of stages IB-II NSCLC, improving absolute 5-year survival by 15% and median survival by 21 months. This cost-effectiveness analysis of adjuvant chemotherapy from the perspective of Canada's public health care system was undertaken based on the JBR.10 study population.

Patients and Methods: The primary outcome of the study was the incremental cost effectiveness ratio (ICER) expressed in dollars per life-year gained (LYG). Direct medical resource utilization data were collected retrospectively from trial data and medical records of patients enrolled in the JBR.10 study at the five largest accruing Canadian centers, from the time of random assignment until death or study closure (April 2004). Survival and available costs (2005 Canadian dollars [$CAD]) are presented both with and without discounting at 5% per year.

Results: Utilization data were collected from 172 Canadian patients (36% of the trial population), 85 randomly assigned to observation and 87 randomly assigned to chemotherapy. The mean costs of treatment per patient in the observation and adjuvant chemotherapy arms were $23,878 and $31,319, respectively, with an ICER of CAD$7,175/LYG discounted (95% CI, –$3,463 to $41,565), and $10,096/LYG undiscounted (95% CI, –$819 to $55,651).

Conclusion: Adjuvant vinorelbine plus cisplatin is a highly cost effective treatment that compares very favorably with other standard health care interventions.

Supported by the Department of Hematology and Medical Oncology, Princess Margaret Hospital, the University of Toronto, and the National Cancer Institute of Canada Clinical Trials Group.

Presented in part at the 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006, Atlanta, GA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.