human
***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: PURPOSE To compare the expenditures associated with single-agent paclitaxel ( Taxol ) with those of best supportive care as treatment for stage IV non-small-cell lung cancer ( NSCLC ) . METHODS The primary data sets of 2 phase II trials of paclitaxel in advanced NSCLC were obtained . Paclitaxel delivery costs were estimated at the Ottawa Regional Cancer Centre using the mean paclitaxel dose from the 2 phase II trials , 214 mg/m2 , a 3-week schedule and a median of 3 treatment cycles . Data regarding dosage , costs and survival were incorporated into the Statistics Canada POpulation HEalth Model ( POHEM ) , which generated hypothetical cohorts of patients treated either with best supportive care or paclitaxel .  The POHEM model assigned diagnostic workup , treatment , disease progression and survival characteristics to each of these cohorts and tabulated the costs associated with each . RESULTS The total cost of administering 3 cycles of chemotherapy was Can$8143 per patient . The strategy of treating NSCLC patients with paclitaxel cost $ 3375 more per patient than best supportive care . On the basis of the difference in survival duration between stage IV patients treated in the best supportive care arm of a previous National Cancer Institute of Canada trial and those represented in the pooled phase II survival results , the cost per life-year saved was $ 4778 . For sensitivity analyses , the days of hospitalization for terminal care , number of cycles given and survival benefit produced were varied . The sensitivity analysis produced a cost per life-year saved of up to $ 21,377 under the least favourable assumptions . CONCLUSION If large phase III trials confirm the survival benefits observed in the phase II trials , paclitaxel can be considered to be a cost-effective agent in the management of advanced NSCLC Summary The aim of this study was to assess the cost-effectiveness of combination chemotherapy with paclitaxel/cisplatin , compared with st and ard etoposide/cisplatin in patients with advanced non-small cell lung cancer ( NSCLC ) . We obtained the primary survival and re source utilization data from a large three-arm r and omized trial comparing : paclitaxel 135 mg m–2 by 24-h intravenous ( i.v . ) infusion + cisplatin ; paclitaxel 250 mg m–2 by 24-h i.v . infusion + cisplatin + granulocyte colony-stimulating factor ( G-CSF ) ; and st and ard etoposide/cisplatin in patients with stage IIIb or IV NSCLC . We also modelled the regimens with paclitaxel 135 mg m–2 + cisplatin administered as an outpatient by 3-h infusion , as clinical data suggest that this is equivalent to 24-h infusion . We collected costing data from the Ottawa Regional Cancer Centre and applied it to the re sources consumed in the r and omized trial . We integrated these data into the Statistics Canada POpulation HEalth Model ( POHEM ) , which generated hypothetical cohorts of patients treated with each regimen . The POHEM model assigned diagnostic work-up , treatment , disease progression and survival characteristics to each individual in these cohorts and tabulated the costs associated with each . We did sensitivity analyses around the costs of chemotherapy and its administration , and the survival differences between the two regimens . All costs are in 1997 Canadian dollars ( $ 1.00 Canadian ~ £ 0.39 sterling ) . The perspective is that of the Canadian health care system . In the trial , the two paclitaxel-containing arms had almost identical survival curves with a median survival of 9.7 months compared with 7.4 months for etoposide/cisplatin . As administered in the trial , paclitaxel/cisplatin  cost $ 76 370 per life-year gained ( LYG ) and  paclitaxel/cisplatin/G-CSF  $ 138 578 per LYG relative to etoposide/cisplatin . However , when modelled as an outpatient 3-h infusion , paclitaxel/cisplatin was moderately cost-effective at $ 30 619 per LYG . When compared with historical controls treated with best supportive care , this regimen of paclitaxel/cisplatin cost $ 4539 per LYG . Assuming a 3-h paclitaxel infusion yields the same survival advantage as the 24-h infusion did in the r and omized trial , paclitaxel/cisplatin is a cost-effective improvement over st and ard etoposide/cisplatin for patients with advanced non-small cell lung cancer Statistics Canada ( Ottawa , Canada ) is developing a population health model ( POHEM ) that simulates the health and common illnesses of Canadians . The POHEM incorporates a model of lung cancer management based on Canadian practice , which has been used to estimate the total direct care costs of treating all lung cancer cases diagnosed in Canada in 1988 . One of the potential uses of the POHEM is to evaluate the cost and cost effectiveness of new therapeutic interventions as they are introduced into practice . Gemcitabine , a new nucleoside analog with a broad spectrum of antitumor activity , has been evaluated in the model and estimates have been made of its cost effectiveness in the management of lung cancer over a range of drug costs per treatment cycle ( $ Cdn 800 to $ Cdn 1,800 ) . The  survival of stage IV non-small cell lung cancer ( NSCLC ) patients treated on an international trial of gemcitabine ( E018 ) was used to estimate the potential survival gain relative to the survival of stage IV NSCLC patients managed with best supportive care on a r and omized trial conducted by the National Cancer Institute of Canada . Sensitivity analyses were performed assuming that the survival benefit was 25 % and 50 % less than that reported in the E018 trial . Based on the apparent survival advantage of the E018 trial , the cost per life-year gained ranged from $ Cdn 1,609 to $ Cdn 9,529 depending on the cost per treatment cycle . At the greatest cost per cycle ( $ Cdn 1,800 ) and with survival reduced by 50 % as compared with the E018 result , the cost per life-year gained was estimated to be $ Cdn 16,230 . From these estimates of direct care costs in the Canadian health care system , gemcitabine appears to be a cost-effective intervention for advanced NSCLC Le Chevalier and colleagues have reported results of a r and omized controlled clinical trial comparing vinorelbine alone , versus vinorelbine combined with cisplatin , versus st and ard treatment consisting of vindesine and cisplatin in the treatment of patients with advanced non-small-cell lung cancer ( NSCLC ) . Data on survival in the three study arms and estimates of the re sources used to treat these patients were extracted from the publication and inserted into Statistics Canada 's POpulation HEalth Model ( POHEM ) . This model includes data on diagnostic methods , treatment , and outcomes appropriate for stage at presentation , health care utilization , and direct care costs ( $ Canadian ) for best supportive care and for several " st and ard " chemotherapy regimens used to treat advanced NSCLC . POHEM was then used to model the cost of care per patient and the total burden of cost on the Canadian health care system for each of the chemotherapy treatment strategies and for best supportive care . Based on the published survival curves for each of the vinorelbine regimens , it was possible to estimate the survival gain relative to the st and ard chemotherapy regimens and to best supportive care , and to estimate their cost-effectiveness as cost per life year gained . Based on this analysis , the most cost-effective st and ard regimen relative to best supportive care was vinblastine/cisplatin , as it increased average survival while reducing costs by $ 2,846 per case . Vinorelbine/cisplatin increased survival to a greater degree , but inpatient administration costs associated with the delivery of cisplatin increased treatment costs by $ 2,983 per case and result ed in a cost-effectiveness ratio of $ 6,386 per life year gained . As high-dose cisplatin is not routinely administered in the inpatient setting in Canadian institutions , estimates were made of the cost of outpatient administration . The cost of outpatient care was $ 55 less per case demonstrating that this is the most cost-effective way to administer the regimen . Relative to etoposide/cisplatin and vinblastine/cisplatin , outpatient vinorelbine/cisplatin proved to be cost-effective . Various chemotherapy regimens used in the management of advanced NSCLC all fall within the boundaries of cost-effectiveness generally accepted for health care interventions in Canada . Therefore , cost and cost-effectiveness should not be barriers to the utilization of vinorelbine/cisplatin in Canada BACKGROUND Although the use of salvage chemotherapy in advanced non-small cell lung cancer ( NSCLC ) is controversial , pretreated symptomatic patients often need some kind of treatment to achieve symptoms relief .  Gemcitabine is one of the most active new drugs in advanced NSCLC and preliminary reports suggest that it is active also in patients previously treated with platinum compounds . AIM to evaluate activity and toxicity and the effect on quality of life of gemcitabine in platinum-pretreated patients with advanced NSCLC . METHODS single-stage phase 2 trial with p0 = 5 % , p1 = 20 % , alfa = 5 % , beta = 10 % ; 34 patients required and 4 objective responses expected to warrant further studies . Gemcitabine was administered at dose of 1000 mg/m2 , i.v . , d 18 - 15 , every 4 weeks , for a maximum of 6 cycles . Quality of life was measured by EORTC C-30 and LC-13 question naires . RESULTS from September 1996 to July 1998 , 30 patients have been enrolled . There were 6 ( 20 % exact 95 % CI 8 - 39 % ) partial responses ( 2 responses were in pts with brain metastases and 2 in patients progressed during first-line chemotherapy ) . All patients ( but one died because myocardial infa rct ion , progressed ; median time to progression was 10 weeks ( 95 % CI 7 - 12 ) ; 28 patients died ; median survival was 22 weeks ( 95 % CI 17 - 29 ) . Quality of life analysis showed no significant change but for the improvement of cough after 3 cycles of chemotherapy . There was no severe toxicity . CONCLUSION gemcitabine is active as second line for patients with advanced NSCLC who received platinum-based first line treatment . In view of such results r and omized trials comparing gemcitabine versus best supportive care are warranted In order to explore non-cisplatin containing regimens for advanced non-small cell lung cancer , Cancer and Leukemia Group B conducted a r and omized Phase-II study of two novel combinations , paclitaxel/ifosfamide and vinorelbine/ifosfamide . Both regimens were active with a 38 % response rate ( 95 % CI : 24 % , 53 % ) and 31 % ( 95 % CI : 18 % , 47 % ) , respectively . Median survivals were 8.5 and 7.4 months . Toxicity , mostly neutropenia , was acceptable . These two combinations establish a ' proof of principle ' that non-cisplatin containing regimens also have activity in this setting An economic evaluation was undertaken , using data from European and Canadian r and omised controlled trials of chemotherapy in advanced non-small cell lung cancer ( NSCLC ) , to determine the cost and cost-effectiveness of single-agent vinorelbine ( Navelbine , NVB ) therapy and NVB in combination with cisplatin ( NVB-P ) compared to vindesine in combination with cisplatin ( VDS-P ) , st and ard regimens including VP-16-cisplatin ( VP-16-P ) and vinblastine-cisplatin ( VLB-P ) and best supportive care ( BSC ) . The Population Health Model ( POHEM ) developed by Statistics Canada was used to model the cost of care per patient , the total burden of cost to the Canadian healthcare system and the cost-effectiveness of the therapeutic interventions relative to BSC and to st and ard chemotherapy regimens , expressed as the cost per life year gained ( LYG ) . Based on this analysis , VLB-P proved to be the most cost-effective chemotherapy regimen relative to BSC , as it increased average survival by 0.27 years while reducing costs by $ 3265 per case . NVB-P increased survival to a greater degree ( 0.44 years/patient ) while inpatient administration increased costs by $ 2451 per case , for a cost-effectiveness ratio of $ 5551 per LYG . Outpatient administration , which reduced the cost of care per case by $ 473 , was shown in the model to be the most cost-effective way to administer this regimen . Relative to VP-16-P and VLB-P , outpatient NVB-P regimen proved to be cost-effective at $ 7902 and $ 16404 per LYG , respectively . Based on our estimates , a variety of chemotherapy regimens , including outpatient NVB-P , are cost-effective in the management of advanced ( Stage IV ) NSCLC and competitive with some commonly used healthcare interventions . Therefore , cost and cost-effectiveness should not be barriers to the utilisation of NVB-P therapy in Canada Although chemotherapy costs have not been highlighted traditionally , there is increasing pressure to demonstrate the value of new treatments within the health care budget . Pharmaceutical companies are assessing the economic value of their products before launch . Gemcitabine is a nucleoside analogue developed for use in solid tumours . The purpose of this model was to investigate the clinical outcomes and potential cost savings for gemcitabine used as monotherapy compared to cisplatin and etoposide combination therapy in late stage non-small cell lung 
    Output:
    
agent
***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: PURPOSE To compare the expenditures associated with single-agent paclitaxel ( Taxol ) with those of best supportive care as treatment for stage IV non-small-cell lung cancer ( NSCLC ) . METHODS The primary data sets of 2 phase II trials of paclitaxel in advanced NSCLC were obtained . Paclitaxel delivery costs were estimated at the Ottawa Regional Cancer Centre using the mean paclitaxel dose from the 2 phase II trials , 214 mg/m2 , a 3-week schedule and a median of 3 treatment cycles . Data regarding dosage , costs and survival were incorporated into the Statistics Canada POpulation HEalth Model ( POHEM ) , which generated hypothetical cohorts of patients treated either with best supportive care or paclitaxel .  The POHEM model assigned diagnostic workup , treatment , disease progression and survival characteristics to each of these cohorts and tabulated the costs associated with each . RESULTS The total cost of administering 3 cycles of chemotherapy was Can$8143 per patient . The strategy of treating NSCLC patients with paclitaxel cost $ 3375 more per patient than best supportive care . On the basis of the difference in survival duration between stage IV patients treated in the best supportive care arm of a previous National Cancer Institute of Canada trial and those represented in the pooled phase II survival results , the cost per life-year saved was $ 4778 . For sensitivity analyses , the days of hospitalization for terminal care , number of cycles given and survival benefit produced were varied . The sensitivity analysis produced a cost per life-year saved of up to $ 21,377 under the least favourable assumptions . CONCLUSION If large phase III trials confirm the survival benefits observed in the phase II trials , paclitaxel can be considered to be a cost-effective agent in the management of advanced NSCLC Summary The aim of this study was to assess the cost-effectiveness of combination chemotherapy with paclitaxel/cisplatin , compared with st and ard etoposide/cisplatin in patients with advanced non-small cell lung cancer ( NSCLC ) . We obtained the primary survival and re source utilization data from a large three-arm r and omized trial comparing : paclitaxel 135 mg m–2 by 24-h intravenous ( i.v . ) infusion + cisplatin ; paclitaxel 250 mg m–2 by 24-h i.v . infusion + cisplatin + granulocyte colony-stimulating factor ( G-CSF ) ; and st and ard etoposide/cisplatin in patients with stage IIIb or IV NSCLC . We also modelled the regimens with paclitaxel 135 mg m–2 + cisplatin administered as an outpatient by 3-h infusion , as clinical data suggest that this is equivalent to 24-h infusion . We collected costing data from the Ottawa Regional Cancer Centre and applied it to the re sources consumed in the r and omized trial . We integrated these data into the Statistics Canada POpulation HEalth Model ( POHEM ) , which generated hypothetical cohorts of patients treated with each regimen . The POHEM model assigned diagnostic work-up , treatment , disease progression and survival characteristics to each individual in these cohorts and tabulated the costs associated with each . We did sensitivity analyses around the costs of chemotherapy and its administration , and the survival differences between the two regimens . All costs are in 1997 Canadian dollars ( $ 1.00 Canadian ~ £ 0.39 sterling ) . The perspective is that of the Canadian health care system . In the trial , the two paclitaxel-containing arms had almost identical survival curves with a median survival of 9.7 months compared with 7.4 months for etoposide/cisplatin . As administered in the trial , paclitaxel/cisplatin  cost $ 76 370 per life-year gained ( LYG ) and  paclitaxel/cisplatin/G-CSF  $ 138 578 per LYG relative to etoposide/cisplatin . However , when modelled as an outpatient 3-h infusion , paclitaxel/cisplatin was moderately cost-effective at $ 30 619 per LYG . When compared with historical controls treated with best supportive care , this regimen of paclitaxel/cisplatin cost $ 4539 per LYG . Assuming a 3-h paclitaxel infusion yields the same survival advantage as the 24-h infusion did in the r and omized trial , paclitaxel/cisplatin is a cost-effective improvement over st and ard etoposide/cisplatin for patients with advanced non-small cell lung cancer Statistics Canada ( Ottawa , Canada ) is developing a population health model ( POHEM ) that simulates the health and common illnesses of Canadians . The POHEM incorporates a model of lung cancer management based on Canadian practice , which has been used to estimate the total direct care costs of treating all lung cancer cases diagnosed in Canada in 1988 . One of the potential uses of the POHEM is to evaluate the cost and cost effectiveness of new therapeutic interventions as they are introduced into practice . Gemcitabine , a new nucleoside analog with a broad spectrum of antitumor activity , has been evaluated in the model and estimates have been made of its cost effectiveness in the management of lung cancer over a range of drug costs per treatment cycle ( $ Cdn 800 to $ Cdn 1,800 ) . The  survival of stage IV non-small cell lung cancer ( NSCLC ) patients treated on an international trial of gemcitabine ( E018 ) was used to estimate the potential survival gain relative to the survival of stage IV NSCLC patients managed with best supportive care on a r and omized trial conducted by the National Cancer Institute of Canada . Sensitivity analyses were performed assuming that the survival benefit was 25 % and 50 % less than that reported in the E018 trial . Based on the apparent survival advantage of the E018 trial , the cost per life-year gained ranged from $ Cdn 1,609 to $ Cdn 9,529 depending on the cost per treatment cycle . At the greatest cost per cycle ( $ Cdn 1,800 ) and with survival reduced by 50 % as compared with the E018 result , the cost per life-year gained was estimated to be $ Cdn 16,230 . From these estimates of direct care costs in the Canadian health care system , gemcitabine appears to be a cost-effective intervention for advanced NSCLC Le Chevalier and colleagues have reported results of a r and omized controlled clinical trial comparing vinorelbine alone , versus vinorelbine combined with cisplatin , versus st and ard treatment consisting of vindesine and cisplatin in the treatment of patients with advanced non-small-cell lung cancer ( NSCLC ) . Data on survival in the three study arms and estimates of the re sources used to treat these patients were extracted from the publication and inserted into Statistics Canada 's POpulation HEalth Model ( POHEM ) . This model includes data on diagnostic methods , treatment , and outcomes appropriate for stage at presentation , health care utilization , and direct care costs ( $ Canadian ) for best supportive care and for several " st and ard " chemotherapy regimens used to treat advanced NSCLC . POHEM was then used to model the cost of care per patient and the total burden of cost on the Canadian health care system for each of the chemotherapy treatment strategies and for best supportive care . Based on the published survival curves for each of the vinorelbine regimens , it was possible to estimate the survival gain relative to the st and ard chemotherapy regimens and to best supportive care , and to estimate their cost-effectiveness as cost per life year gained . Based on this analysis , the most cost-effective st and ard regimen relative to best supportive care was vinblastine/cisplatin , as it increased average survival while reducing costs by $ 2,846 per case . Vinorelbine/cisplatin increased survival to a greater degree , but inpatient administration costs associated with the delivery of cisplatin increased treatment costs by $ 2,983 per case and result ed in a cost-effectiveness ratio of $ 6,386 per life year gained . As high-dose cisplatin is not routinely administered in the inpatient setting in Canadian institutions , estimates were made of the cost of outpatient administration . The cost of outpatient care was $ 55 less per case demonstrating that this is the most cost-effective way to administer the regimen . Relative to etoposide/cisplatin and vinblastine/cisplatin , outpatient vinorelbine/cisplatin proved to be cost-effective . Various chemotherapy regimens used in the management of advanced NSCLC all fall within the boundaries of cost-effectiveness generally accepted for health care interventions in Canada . Therefore , cost and cost-effectiveness should not be barriers to the utilization of vinorelbine/cisplatin in Canada BACKGROUND Although the use of salvage chemotherapy in advanced non-small cell lung cancer ( NSCLC ) is controversial , pretreated symptomatic patients often need some kind of treatment to achieve symptoms relief .  Gemcitabine is one of the most active new drugs in advanced NSCLC and preliminary reports suggest that it is active also in patients previously treated with platinum compounds . AIM to evaluate activity and toxicity and the effect on quality of life of gemcitabine in platinum-pretreated patients with advanced NSCLC . METHODS single-stage phase 2 trial with p0 = 5 % , p1 = 20 % , alfa = 5 % , beta = 10 % ; 34 patients required and 4 objective responses expected to warrant further studies . Gemcitabine was administered at dose of 1000 mg/m2 , i.v . , d 18 - 15 , every 4 weeks , for a maximum of 6 cycles . Quality of life was measured by EORTC C-30 and LC-13 question naires . RESULTS from September 1996 to July 1998 , 30 patients have been enrolled . There were 6 ( 20 % exact 95 % CI 8 - 39 % ) partial responses ( 2 responses were in pts with brain metastases and 2 in patients progressed during first-line chemotherapy ) . All patients ( but one died because myocardial infa rct ion , progressed ; median time to progression was 10 weeks ( 95 % CI 7 - 12 ) ; 28 patients died ; median survival was 22 weeks ( 95 % CI 17 - 29 ) . Quality of life analysis showed no significant change but for the improvement of cough after 3 cycles of chemotherapy . There was no severe toxicity . CONCLUSION gemcitabine is active as second line for patients with advanced NSCLC who received platinum-based first line treatment . In view of such results r and omized trials comparing gemcitabine versus best supportive care are warranted In order to explore non-cisplatin containing regimens for advanced non-small cell lung cancer , Cancer and Leukemia Group B conducted a r and omized Phase-II study of two novel combinations , paclitaxel/ifosfamide and vinorelbine/ifosfamide . Both regimens were active with a 38 % response rate ( 95 % CI : 24 % , 53 % ) and 31 % ( 95 % CI : 18 % , 47 % ) , respectively . Median survivals were 8.5 and 7.4 months . Toxicity , mostly neutropenia , was acceptable . These two combinations establish a ' proof of principle ' that non-cisplatin containing regimens also have activity in this setting An economic evaluation was undertaken , using data from European and Canadian r and omised controlled trials of chemotherapy in advanced non-small cell lung cancer ( NSCLC ) , to determine the cost and cost-effectiveness of single-agent vinorelbine ( Navelbine , NVB ) therapy and NVB in combination with cisplatin ( NVB-P ) compared to vindesine in combination with cisplatin ( VDS-P ) , st and ard regimens including VP-16-cisplatin ( VP-16-P ) and vinblastine-cisplatin ( VLB-P ) and best supportive care ( BSC ) . The Population Health Model ( POHEM ) developed by Statistics Canada was used to model the cost of care per patient , the total burden of cost to the Canadian healthcare system and the cost-effectiveness of the therapeutic interventions relative to BSC and to st and ard chemotherapy regimens , expressed as the cost per life year gained ( LYG ) . Based on this analysis , VLB-P proved to be the most cost-effective chemotherapy regimen relative to BSC , as it increased average survival by 0.27 years while reducing costs by $ 3265 per case . NVB-P increased survival to a greater degree ( 0.44 years/patient ) while inpatient administration increased costs by $ 2451 per case , for a cost-effectiveness ratio of $ 5551 per LYG . Outpatient administration , which reduced the cost of care per case by $ 473 , was shown in the model to be the most cost-effective way to administer this regimen . Relative to VP-16-P and VLB-P , outpatient NVB-P regimen proved to be cost-effective at $ 7902 and $ 16404 per LYG , respectively . Based on our estimates , a variety of chemotherapy regimens , including outpatient NVB-P , are cost-effective in the management of advanced ( Stage IV ) NSCLC and competitive with some commonly used healthcare interventions . Therefore , cost and cost-effectiveness should not be barriers to the utilisation of NVB-P therapy in Canada Although chemotherapy costs have not been highlighted traditionally , there is increasing pressure to demonstrate the value of new treatments within the health care budget . Pharmaceutical companies are assessing the economic value of their products before launch . Gemcitabine is a nucleoside analogue developed for use in solid tumours . The purpose of this model was to investigate the clinical outcomes and potential cost savings for gemcitabine used as monotherapy compared to cisplatin and etoposide combination therapy in late stage non-small cell lung 
    Output:
    