In prostate cancer, VEGF-C up-regulation was shown to be associated with ROS generation

ethods This study was based on the data and information from the OPTIMAL trial, which was undertaken at 22 centres in China. A Markov model was developed to evaluate the costeffectiveness of the two treatment strategies. Decision Model Structure The cost-effectiveness model of advanced NSCLC involved three mutually exclusive health states: PFS, disease progression and death. Fig. 1 shows the structure of the model. At the starting point of the model, all of the patients were in a PFS and received one of treatments below as soon as they entered the PFS state: 1. 150 mg/day erlotinib until disease progression 21147071 or unacceptable toxic effects and 2. Carboplatin-gemcitabine chemotherapy for 4 cycles. The cycle length was 3-weeks for both groups. The transitioning probabilities of the patients between states for each cycle were estimated over a 10-year time horizon, which was chosen to reflect the nature of patients and to obtain the appropriate life expectancy in this patient population. purchase R115777 During each 3-week cycle, the patients remained in a PFS, progressed to a DP state, or died. Once he/she entered the DP state, a patient could either remain in this state or die. The death state absorbed those patients who died from advanced NSCLC or from any other causes. From the perspective of the Chinese health care system, we use Markov model to estimate the cost, life expectancy gained and quality-adjusted life-year gained for both groups. The cost-effectiveness outcomes of both regimens are presented as incremental cost-effectiveness ratios. Cost-Effectiveness of Erlotinib Alone versus CG with the eighth cycle, the costs for patient receiving erlotinib are zero due to the donations of Roche China. The company had promised that all eligible Chinese patients would be able to use erlotinib free of charge after being treated with erlotinib continuously 5 months. We obtained the mean costs of the DP state per month indirectly from the public literature. Zeng et al reported that the mean cost of treatment for advanced NSCLC patients in the DP state was approximately US $14,519; dividing this value by 12 yielded $1,209.96, which was the mean cost of the disease progression state per month. In the model, the costs were discounted at 3% annually to account for the current value. The costs were expressed in U.S. dollar and the price year was 2010. Health state utilities The health utilities for each state in this model were obtained from the public literature. These values represented the preferences of patients for various health states, with scores ranging from 1 to 0. The base health utility of PFS is 0.653. Given the main adverse events, the health utility of PFS at the CG group was adjusted to 0.56 and the health utility of PFS in the erlotinib group 16873882 remained in 0.65. The utility scores for the DP state ranged from 0.673 to 0.473. Furthermore, 0.47 was used for the health utility of the DP for both of the groups, as indicated in the other literature. Resource Drug costs carboplatin Gemcitabine erlotinib Administration costs Grade I nursing per day Grade II nursing per day Arteriovenous catheter nursing per day Material per set Preparation of chemotherapeutics per set Supportive care costs Ondanstron Pantoprazole Dexamethasone Unit cost 11.71 79.06 657.05 Sensitivity analysis Each parameter, such as transition probability, costs, and health utility, was included in the Markov model. To allow for uncertainties of those parameters and to estimate the model robu