***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The median age of newly diagnosed patients with non-small cell lung cancer ( NSCLC ) is 67 years , and one-third of patients are older than 75 years . Elderly patients are more vulnerable to the adverse effects of chemotherapy , and targeted therapy might thus be a relevant alternative . The objective of this study was to assess the cost-effectiveness of erlotinib followed by chemotherapy after progression , compared to the reverse strategy , in fit elderly patients with advanced NSCLC participating in a prospect i ve r and omized phase 2 trial ( GFPC0504 ) . Methods Outcomes ( PFS and overall survival ) and costs ( limited to direct medical costs , from the third-party payer perspective ) were prospect ively collected until second progression . Costs after progression and health utilities ( based on disease states and grade 3–4 toxicities ) were derived from the literature . Results Median overall survival , QALY and total costs for the erlotinib-first strategy were respectively 7.1 months , 0.51 and 27 734 € , compared to 9.4 months , 0.52 and 31 688 € for the chemotherapy-first strategy . The Monte Carlo simulation demonstrates that the two strategies do not differ statistically . Conclusion In terms of cost effectiveness , in fit elderly patients with NSCLC  , erlotinib followed by chemotherapy compares well with the reverse strategy OBJECTIVES A recent r and omized study showed switch maintenance with pemetrexed after nonpemetrexed-containing first-line chemotherapy in patients with advanced nonsmall-cell lung cancer to prolong overall survival by 2.8 months . We examined the cost-effectiveness of pemetrexed in this indication , from the perspective of the Swiss health care system , and assessed the influence of the costs of best supportive care ( BSC ) on overall cost-effectiveness . METHODS A Markov model was constructed based on the pemetrexed maintenance study , and the incremental cost-effectiveness ratio ( ICER ) of adding pemetrexed until disease progression was calculated as cost per quality -adjusted life-year gained . Uncertainties concerning the costs of BSC on the ICER were addressed . RESULTS The base case ICER for maintenance therapy with pemetrexed plus BSC compared to BSC alone was € 106,202 per quality -adjusted life-year gained . Varying the costs for BSC had a marked effect . Assuming a reduction of the costs for BSC by 25 % in the pemetrexed arm result ed in an ICER of € 47,531 per quality -adjusted life-year , which is below predefined criteria for cost effectiveness in Switzerl and . CONCLUSIONS Switch maintenance with pemetrexed in patients with advanced nonsquamous-cell lung cancer after st and ard first-line chemotherapy is not cost-effective . Uncertainties on the re source use and costs for BSC have a large influence on the cost-effectiveness calculation and should be reported in more detail BACKGROUND / OBJECTIVE Non-platinum-based chemotherapy is a potential alternative to platinum doublet therapy for advanced non-small cell lung cancer in selected patients . We determined the cost-effectiveness of gemcitabine/vinorelbine ( GEMVIN ) , versus cisplatin/gemcitabine ( PG ) or cisplatin/vinorelbine ( PV ) , from a government payer perspective . METHODS Results from a r and omized trial of GEMVIN versus PG or PV demonstrated no significant difference in global quality of life ( primary endpoint ) or overall survival between regimens , but superior progression-free survival for platinum-based regimens . A cost analysis was conducted using direct medical costs of treatment , grade 3 or 4 toxicity management , and investigations for the mean number of cycles per study arm . Costs were calculated using Canadian dollars in 2005 , and then in 2013 after drug patent expiry . RESULTS In 2005 , GEMVIN was the most expensive regimen ( $ 6868 ) , and PV the least expensive ( $ 4650 ) , with an incremental cost of GEMVIN over PV of $ 2218 . Diagnostic and administration costs did not differ significantly among regimens ; GEMVIN had the lowest toxicity costs . The principal cost driver in 2005 was the cost of chemotherapy . In 2013 , toxicity and administration costs emerged as major drivers ; GEMVIN was less costly than PV and PG , ( cost savings of $ 413 over PV ) . CONCLUSION Despite similar outcomes , GEMVIN was more expensive than PV or PG in 2005 because of higher chemotherapy costs . By 2013 , after chemotherapy drug patent expiry , GEMVIN became the least costly regimen . Economic considerations in oncology change over time , and should be revisited in policy decisions based on cost Background Platinum-doublet , first-line treatment of locally advanced or metastatic non-small cell lung cancer ( NSCLC ) is limited to 4–6 cycles . An alternative strategy used to prolong the duration of first-line treatment and extend survival in metastatic NSCLC is first-line maintenance therapy . Erlotinib was approved for first-line maintenance in a stable disease population following results from a r and omized , controlled Phase III trial comparing erlotinib with best supportive care . We aim ed to estimate the incremental cost-effectiveness of erlotinib 150 mg/day versus best supportive care when used as first-line maintenance therapy for patients with locally advanced or metastatic NSCLC and stable disease . Methods An economic decision model was developed using patient-level data for progression-free survival and overall survival from the SATURN ( SequentiAl Tarceva in UnResectable NSCLC ) study . An area under the curve model was developed ; all patients entered the model in the progression-free survival health state and , after each month , moved to progression or death . A time horizon of 5 years was used . The model was conducted from the perspective of national health care payers in France , Germany , and Italy . Probabilistic sensitivity analyses were performed . Results Treatment with erlotinib in first-line maintenance result ed in a mean life expectancy of 1.39 years in all countries , compared with a mean 1.11 years with best supportive care , which represents 0.28 life-years ( 3.4 life-months ) gained with erlotinib versus best supportive care . In the base-case analysis , the cost per life-year gained was € 39,783 , € 46,931 , and € 27,885 in France , Germany , and Italy , respectively . Conclusion Erlotinib is a cost-effective treatment option when used as first-line maintenance therapy for locally advanced or metastatic NSCLC Introduction Lung cancer , the most prevalent malignant cancer in the world , remains a serious threat to public health . Recently , a large number of studies have shown that an epidermoid growth factor receptor-tyrosine kinase inhibitor ( EGFR TKI ) , Erlotinib , has significantly better efficacy and is better tolerated in advanced non-small cell lung cancer ( NSCLC ) patients with a positive EGFR gene mutation . However , access to this drug is severely limited in China due to its high acquisition cost . Therefore , we decided to conduct a study to compare cost-effectiveness between erlotinib monotherapy and carboplatin-gemcitabine ( CG ) combination therapy in patients with advanced EGFR mutation-positive NSCLC . Methods A Markov model was developed from the perspective of the Chinese health care system to evaluate the cost-effectiveness of the two treatment strategies ; this model was based on data from the OPTIMAL trial , which was undertaken at 22 centres in China . The 10-year quality -adjusted life years ( QALYs ) , direct costs , and incremental cost-effectiveness ratio ( ICER ) were estimated . To allow for uncertainties within the parameters and to estimate the model robustness , one-way sensitivity analysis and probabilistic sensitivity analysis were performed . Results The median progression-free survival ( PFS ) obtained from Markov model was 13.2 months ( 13.1 months was reported in the trial ) in the erlotinib group while and 4.64 months ( 4.6 months was reported in the trial ) in the CG group . The QALYs were 1.4 years in the erlotinib group and 1.96 years in the CG group , indicating difference of 0.56 years . The ICER was most sensitive to the health utility of DP ranged from $ 58,584.57 to $ 336,404.2 . At a threshold of $ 96,884 , erlotinib had a 50%probability of being cost-effective . Conclusions Erlotinib monotherapy is more cost-effective compared with platinum-based doublets chemotherapy as a first-line therapy for advanced EGFR mutation- positive NSCLC patients from within the Chinese health care system OBJECTIVE To compare the effectiveness and cost-effectiveness of erlotinib versus gefitinib as first-line treatment of epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancer patients . DESIGN . Indirect treatment comparison and a cost-effectiveness assessment . SETTING Hong Kong . PATIENTS Those having epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancer . INTERVENTIONS Erlotinib versus gefitinib use was compared on the basis of four relevant Asian phase-III r and omised controlled trials : one for erlotinib ( OPTIMAL ) and three for gefitinib ( IPASS ; NEJGSG ; WJTOG ) . The cost-effectiveness assessment model simulates the transition between the health states : progression-free survival , progression , and death over a lifetime horizon . The World Health Organization criterion ( incremental cost-effectiveness ratio <3 times of gross domestic product/capita : < US$ 102 582 ; approximately < HK$798 078 ) was used to rate cost-effectiveness . RESULTS The best fit of study characteristics and prognostic patient characteristics were found between the OPTIMAL and IPASS trials . Comparing progression-free survival hazard ratios of erlotinib versus gefitinib using only these r and omised controlled trials in an indirect treatment comparison result ed in a statistically significant progression-free survival difference in favour of erlotinib ( indirect treatment comparison hazard ratio=0.33 ; 95 % confidence interval , 0.19 - 0.58 ; P=0.0001 ) . The cost-effectiveness assessment model showed that the cost per progression-free life year gained and per quality -adjusted life year gained was at acceptable values of US$ 39 431 ( approximately HK$306 773 ) and US$ 62 419 ( approximately HK$485 619 ) for erlotinib versus gefitinib , respectively . CONCLUSION The indirect treatment comparison of OPTIMAL versus IPASS shows that erlotinib is significantly more efficacious than gefitinib . Furthermore , the cost-effectiveness assessment indicates that the incremental cost-effectiveness ratios are well within an acceptable range in relation to the survival benefits obtained . In conclusion , erlotinib is cost-effective compared to gefitinib for first-line epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancer patients Abstract Background : During the 1990s , a number of new cytotoxic agents with clinical ly relevant activity in non-small-cell lung cancer ( NSCLC ) , and with a more favourable therapeutic index than drugs already in use , became available . Given the high prices of these new drugs and the large number of patients affected , it is important to compare the relative benefits and costs of these treatments with the existing regimens before treatment policy decisions are changed . Purpose : An economic evaluation of three different regimens of chemotherapy in patients with advanced NSCLC was performed from the perspective of the Dutch health insurance system using tariffs valid for 2002 . The economic evaluation was integrated into a phase III clinical trial in which the reference regimen cisplatinpaclitaxel was compared with two experimental regimens : cisplatin-gemcitabine and gemcitabine-paclitaxel . Material s and methods : Unit costs were applied to re source use data collected prospect ively on case report forms during the trial . The average total ( uncensored ) cost per patient was determined for each of the treatment groups . The principal outcome measure for the economic evaluation was the estimated mean survival time per treatment group . This outcome was then incorporated into incremental cost-effectiveness ratios based on costs corrected for censoring . The impact of uncertainty was assessed by bootstrap techniques , and the analysis and interpretation of the data focused on the bivariate density of differences in outcomes and costs in the incremental cost-effectiveness plane . The final results were summarised by the derivation of cost-effectiveness acceptability curves . Results : The estimated mean survival time was equivalent in the two cisplatinbased regimens with largely overlapping confidence intervals . There was a 99 % probability that cisplatin-gemcitabine is the least costly regimen of the two and a 72 % probability that this regimen reduces costs while at the same time improving survival . Compared with cisplatin-paclitaxel , the gemcitabine-paclitaxel regimen engendered a borderline significant reduction in mean survival time combined with an almost 90 % probability of an increase in costs . Conclusion : The two cisplatin-based regimens are equivalent in terms of survival , but cisplatin-gemcitabine may reduce costs by approximately € 2000 per patient compared with cisplatin-paclitaxel . Gemcitabine-paclitaxel is a dominated option with higher costs and a reduction in mean survival time compared with cisplatinpaclitaxel BACKGROUND A large proportion of elderly patients ( > 70 years ) with newly diagnosed NSCLC are shown to be frail by a comprehensive geriatric assessment . This population is more vulnerable to adverse effects of chemotherapy and might thus benefit more from targeted therapy . The objective of this study was to assess the cost-effectiveness of erlotinib followed by chem 
    Output:
    
For all primary chemotherapy agents , use of carboplatin is associated with slightly higher costs than cisplatin .