Cost-Effectiveness Analysis of Amifostine (Ethyol©) in Patients with Non-Small Cell Lung Cancer

Purpose: While amifostine has been demonstrated to reduce the toxicity of some antineoplastic regimens, it is costly and its value in NSCLC is unknown. This analysis determined the cost-effectiveness of administering amifostine to patients with NSCLC from a hospital'S perspective.Methods: A Markov model was developed to predict the costs of care for patients receiving cisplatin, carboplatin, or paclitaxel, with and without amifostine. Each monthly cycle, patients received chemotherapy or had it held. Outcomes and costs of toxicity (febrile neutropenia, thrombocytopenia, and anemia) were assigned to patients each month at a rate consistent with their treatment group. Inputs were derived from a clinical patient registry (patient identification), medication dispensing (transition rates) and laboratory databases (blood product administration), clinical literature (effect of amifostine), and costing catalogs (cost of blood products, medications, and their administration). One-way sensitivity analyses and Monte Carlo analysis were conducted.Results: Fifty-eight patients with NSCLC made 199 visits for chemotherapy during the study period. Paclitaxel was administered 39% of the time, carboplatin 38%, and cisplatin 23%. Eight units of packed red blood cells were required and four patients were admitted for febrile neutropenia. Average cost for amifostine was $4421 compared with $2709 for controls (difference $1711). For every 100 patients treated, 8 adverse events were avoided with an incremental cost-effectiveness ratio of $21,388 per adverse event avoided.Conclusion: Amifostine results in higher treatment costs to the hospital when used for preventing toxicity from common NSCLC antineoplastic regimens. Further analysis is warranted including outcomes and costs of non-hematologic toxicities and radiation therapy.