OBJECTIVES: This study aims to assess the cost-utility of pemetrexed plus platinum-based for unresectable malignant pleural mesothelioma (MPM).

METHODS: A cost-utility analysis was conducted using a Markov model. A societal perspective and life-time horizon were applied. Variables used in the model were derived from primary data collection, consulting MPM specialists, and reviewing both local and international literature. Sensitivity and sub-group analyses were also performed. Budget impact in the view of government was analysed.

RESULTS: The cost-effectiveness ratios (ICERs) were calculated at 1,726,084 Baht per QALY gained for pemetrexed plus cisplatin and 707,592 Baht per QALY gained for pemetrexed plus carboplatin. Sub-group analysis shows pemetrexed plus cisplatin would become cost-effective if it was decreased more than 96% of pemetrexed prices in both strength of 100 and 500 milligrams. While pemetrexed plus carboplatin would never got a chance of being cost-effective although the price of pemetrexed was reduced due to a high budget of best supportive care. Pemetrexed plus cisplatin and carboplatin will be 5-year budget impacts to government around 32,452,231 Baht and 39,466,259 Baht, respectively.

CONCLUSIONS: Neither pemetrexed plus cisplatin nor carboplatin were not cost-effective in Thai context at a cost-effectiveness threshold at 160,000 Baht per QALY gained. Thai Government should negotiate the price of pemetrexed before including the novel drug in National List of Essential Medicine (NLEM) in Thailand.