Lintasari GA.
Comparative analysis of the treatment.
Comparative analysis of the treatment costs of cisplatinpaclitaxel and cisplatin-gemcitabine in patients with advanced nsclc: a narrative review Gustia Alinda Lintarsari1.
Tri Murti Andayani2*.
Fita Rahmawati2 Master of Clinical Pharmacy.
Faculty of Pharmacy.
Gadjah Mada University.
Yogyakarta.
Indonesia, 2Department of Pharmacology and Clinical Pharmacy.
Faculty of Pharmacy.
Gadjah Mada University.
Yogyakarta.
Indonesia https://doi.
org/10.
22146/ijpther.
ABSTRACT
Submitted: 18-02-2026 Accepted : 24-04-2026 NSCLC.
cisplatin-paclitaxel.
cisplatin-gemcitabine Platinum-based chemotherapy is the first-line treatment for patients with advanced NSCLC.
Cancer treatment is known to be time-consuming and expensive, resulting in numerous studies evaluating the costs of commonly used chemotherapy regimens.
This narrative review aims to analyze and compare two of the most widely used regimens, cisplatin-paclitaxel and cisplatin-gemcitabine, in terms of costs and clinical outcomes.
Articles were searched through various databases, including PubMed.
Science Direct, the Cochrane Library.
Scopus, and Google Scholar, used a combination of keywords (Aucisplatin-paclitaxelAy OR Aucisplatin-gemcitabineA.
AND Auadvanced NSCLCAy AND AucostAy, with a publication timeframe from 2000 to the most recent year of the search.
Articles were reviewed based on topic relevance and content suitability.
Articles were selected based on topic relevance and compliance with the inclusion criteria, then data related to treatment costs were extracted and compared descriptively.
Six of the seven selected articles showed that the cisplatin-gemcitabine regimen resulted in lower total therapy costs than cisplatin-paclitaxel.
Although the clinical outcomes produced by both regimens were generally comparable, cisplatin-gemcitabine tended to have slightly higher efficacy, but not significantly different.
These findings suggest that cisplatin-gemcitabine may be a more cost-effective alternative in the treatment of patients with advanced NSCLC.
The results of this review can be used as supporting data for consideration in selecting chemotherapy regimens for patients with advanced NSCLC.
ABSTRAK
Kemoterapi berbasis platinum menjadi pengobatan lini pertama bagi pasien NSCLC stadium lanjut.
Pengobatan kanker diketahui memakan waktu dan biaya, sehingga banyak penelitian dilakukan dengan topik evaluasi biaya dari regimen kemoterapi yang banyak digunakan.
Tinjauan naratif ini bertujuan untuk menganalisis dan membandingkan dua regimen yang paling banyak digunakan, yakni cisplatin-paclitaxel dan cisplatin-gemcitabine dari segi biaya yang dikeluarkan dan luaran klinis.
Proses penelusuran artikel dilakukan melalui berbagai pangkalan data, yaitu PubMed.
Science Direct.
Cochrane Library.
Scopus, dan Google Scholar dengan menggunakan kombinasi kata kunci (AucisplatinpaclitaxelAy OR Aucisplatin-gemcitabineA.
AND Auadvanced NSCLCAy AND AucostAy, dengan rentang waktu publikasi dari tahun 2000 hingga tahun terakhir pencarian.
Artikel diseleksi berdasarkan relevansi topik dan kesesuaian dengan kriteria inklusi, kemudian data terkait biaya pengobatan diekstraksi dan dibandingkan secara deskriptif.
Enam dari tujuh artikel terpilih menunjukkan bahwa regimen cisplatin-gemcitabine menghasilkan total biaya terapi yang lebih rendah dibandingkan cisplatin-paclitaxel.
Meskipun luaran klinis yang dihasilkan oleh kedua regimen umumnya sebanding, cisplatin-gemcitabine cenderung memiliki efektivitas yang sedikit lebih tinggi, tetapi tidak berbeda secara signifikan.
Temuan ini menunjukkan bahwa cisplatin-gemcitabine dapat menjadi alternatif yang lebih cost-effective dalam pengobatan pasien NSCLC stadium lanjut.
Hasil review ini dapat menjadi data penunjang sebagai pertimbangan dalam pemilihan regimen kemoterapi pada pasien NSCLC stadium lanjut.
*corresponding author: trimurtia@ugm.
Indonesian Journal of Pharmacology and Therapy is licensed under CC BY-NC 4.
IJPTher.
Volume 7.
Number 2, 2026.
INTRODUCTION
In 2022, the WHOAos Global Cancer Observatory (GLOBOCAN) reported that the number of new cancer cases in Indonesia reached 408,661, with 242,988 Lung cancer ranks second in incidence and is one of the main causes of cancer death in the world, and also in Indonesia.
Lung cancer contributes significantly to the cancer death rate in Indonesia, reaching 34,339 .
1 Lung cancer consists of two main types, namely small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).
Non-small cell lung cancer (NSCLC) occurs in 80% of lung cancer cases, and most patients experience advanced stages and metastasis.
2 The recommended first-line chemotherapy regimen for NSCLC therapy is platinumbased chemotherapy, such as cisplatin or carboplatin, combined with paclitaxel, gemcitabine, docetaxel, pemetrexed .
or adenocarcinoma onl.
, and vinorelbine.
Platinum-based chemotherapy is recommended as first-line treatment and is known to increase response rates by approximately 20Ae40% and prolong overall survival by 7Ae12 months.
4 There is no significant difference in response rates and survival between the four platinum-based chemotherapy regimens for advanced NSCLC, but carboplatinpaclitaxel has lower toxicity, while cisplatin-gemcitabine prolongs disease progression time but with higher renal Indonesian Health Insurance Agency (BPJS Kesehata.
expenditures for cancer treatment continue to increase annually and currently represent the second largest cost burden after heart disease.
Although numerous studies have evaluated the effectiveness and costs of chemotherapy regimens in patients with advanced NSCLC, most of these studies were conducted in isolation or within the context of specific healthcare systems, making their results inconclusive and not directly applicable to other Furthermore, few reviews have comprehensively compared the costs and clinical outcomes of cisplatinpaclitaxel and cisplatin-gemcitabine Differences in healthcare financing systems, including within the context of the National Health Insurance (JKN) in Indonesia, make this costcomparative analysis crucial for efficient therapeutic decision-making.
Therefore, this study was conducted to analyze and compare these two regimens in terms of costs and clinical outcomes.
MATERIALS AND METHODS
This article used a narrative review study design, where the analysis was conducted narratively by comparing study results related to treatment The article selection process was conducted by two independent reviewers who separately screened the titles, abstracts, and full texts of articles based on established inclusion and exclusion criteria.
Differences of opinion are resolved through discussion until agreement is reached, or by involving a third reviewer.
Each reviewer was responsible for identifying, selecting, and evaluating the suitability of articles for inclusion in the analysis.
Article searches were conducted Lintasari GA.
Comparative analysis of the treatment.
PubMed.
Science Direct.
Cochrane Library.
Scopus, and Google Scholar databases, with publication dates ranging from 2000 to the last year of the search.
The search strategy used a combination of keywords (AucisplatinpaclitaxelAy OR Aucisplatin-gemcitabineA.
AND Auadvanced NSCLCAy AND AucostAy in each database.
Inclusion criteria for the article search included: .
Health economic studies comparing costs between cisplatin-paclitaxel cisplatingemcitabine regimens.
Cost analysis, cost-effectiveness (CEA), cost-utility analysis (CUA), or costminimization analysis (CMA) studies.
Clinical studies (RCTs and observational studie.
that explicitly included cost data or analysis.
Adult patients (Ou18 year.
diagnosed with advanced NSCLC .
tage iB or IV).
Articles not available in English and focusing solely on clinical effectiveness or side effects were excluded.
Submitted articles were then screened based on title duplication, relevance of title to keywords, inclusion criteria, and concordance of content.
RESULTS
Article selection The initial results of the article search obtained 729 articles, consisting of 404 articles from Science Direct, 322 articles from Google Scholar, 1 article from PubMed, 1 article from the Cochrane Library, and 1 article from Scopus.
The distribution of articles obtained from each database showed a limited number, particularly in PubMed and Scopus.
This was likely due to the use of quite specific inclusion criteria and the studyAos focus on comparing two specific regimens, resulting in a limited number of articles meeting the criteria.
After a selection process based on title duplication, 688 articles were obtained.
Next, a selection was carried out based on the relevance of keywords in the article titles, resulting in 34 articles.
After re-selection based on the inclusion criteria and reading the entire contents of the articles, 7 relevant articles were obtained.
These seven articles were used to discuss the cost comparison of cisplatin-paclitaxel and cisplatin-gemcitabine therapy in patients with advanced stage Non-Small Cell Lung Cancer (NSCLC) .
B and IV) which can then be the basis for selecting the most effective and efficient therapy.
The stages of the search, selection, and results of the article search are presented in a flowchart (FIGURE .
Characteristics of articles This narrative review included seven articles comparing the treatment costs of cisplatin-paclitaxel and cisplatingemcitabine regimens in patients with advanced NSCLC.
These articles included one randomized clinical trial (RCT), one observational study, four cost-minimization analyses, and one cost-effectiveness analysis.
Each article reported several chemotherapy regimens administered to patients with advanced NSCLC, including cisplatinpaclitaxel and cisplatin-gemcitabine.
The cost components analyzed are not limited to chemotherapy costs, but also include various other treatment costs (TABLE .
IJPTher.
Volume 7.
Number 2, 2026.
FIGURE 1.
Article Selection Process Lintasari GA.
Comparative analysis of the treatment.
TABLE 1.
Study Characteristics Author Yildirim et al.
Launois et al.
Pimentel et al.
Neymark et
,10
Schiller et al.
,11
Smit et al.
,12
Lees et al.
,13
Types of Study Retrospective Cost minimization analysis with Markov model Cost minimization analysis using the approach of two randomized phase i trials Cost-effectiveness analysis based on clinical trial data Cost minimization analysis using the approach of two randomized phase i trials Randomized controlled trial Cost minimization and effectiveness analysis based on clinical trial data Research Location Regimen Cost Breakdown Tyrkiye Cisplatin-gemcitabine Cisplatin-paclitaxel Cisplatin-docetaxel Chemotherapy costs France Gemcitabine-cisplatin Vinorelbine-cisplatin Docetaxel-cisplatin Paclitaxel-cisplatin Paclitaxel-carboplatin Chemotherapy costs Administration costs Transportation costs Costs for severe side Initial diagnosis costs Palliative care costs.
Gemcitabine-Cisplatin Vinorelbine-Cisplatin Paclitaxel-Cisplatin Gemcitabine-Cisplatin Docetaxel-Cisplatin Paclitaxel-Carboplatin Chemotherapy costs Administration costs Hospitalization costs due to side effects Other medical costs .
utpatient care, radiotherapy, transfusions, other Netherlands Cisplatin-paclitaxel Cisplatin-gemcitabine Paclitaxel-gemcitabine Inpatient costs Outpatient costs Consultation costs Blood transfusion Supportive medication costs .
Therapy costs .
France.
Germany.
Italy.
Spain, dan England Gemcitabine-vincristine Vincristine-cisplatin Vincristine-gemcitabinecisplatin Paclitaxel-carboplatin Gemcitabine-cisplatin Paclitaxel-cisplatin Docetaxel-cisplatin Chemotherapy costs Administration costs Hospitalization costs due to side effects Other costs Paclitaxel-cisplatin Gemcitabine-cisplatin Paclitaxel-gemcitabine Inpatient costs Outpatient costs Administrative costs Chemotherapy costs Consultation costs Cytotoxic drug costs Transfusion costs Second-line therapy Gemcitabine .
Supportive therapy Cisplatin-gemcitabine Cisplatin-etoposide Platinum-taxanes Chemotherapy costs Chemotherapy administration costs Hospitalization costs Palliative care costs Additional therapy costs .
adiotherapy, surgery, transfusio.
Healthcare provider visits costs Other medication Portugal Netherlands England and Wales IJPTher.
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Number 2, 2026.
TABLE 2.
Cost Comparison of Cisplatin-Paclitaxel and Cisplatin-Gemcitabine Author Service Perspective Cisplatin-Paclitaxel Cost CisplatinGemcitabine Cost Unit Cost Type of Cost Yildirim et al.
Not mentioned 905,92 TL
246,66 TL
TRY/cycle Chemotherapy costs Launois et al.
French health care system in 2004 C9.
C8.
EUR/cycle Total costs of full Pimentel et al.
PortugalAos health care system in 2003 C8.
C7.
EUR/cycle Total costs Neymark et al.
,10
Dutch health insurance system in 2002 C5.
C4.
EUR/cycle Total costs Schiller et al.
,11
National health services of each of the five European countries C9.
166,60
C7.
099,40
EUR/cycle Average therapy costs from five Smit et al.
,12
Dutch health insurance system in 2002 C16.
C14.
EUR/cycle Average total costs per patient Lees et al.
,13
UK health service in A9.
A5.
GBP/cycle Total therapy costs DISCUSSION Cost comparison of cisplatin-paclitaxel and cisplatin-gemcitabine regimens The seven articles analyzed in this review largely demonstrated that the cisplatin-gemcitabine regimen resulted in lower treatment costs compared to cisplatin-paclitaxel (TABLE .
A study by Launois et al.
,8 conducted in France confirmed that the cisplatin-gemcitabine regimen with a three-week dosing schedule was the most cost-effective compared to other combinations.
This is because the regimen can be administered flexibly outside the hospital, thereby reducing outpatient and transportation Other regimens, such as cisplatinvinorelbine, are also quite cost-effective when administered partially at home, but remain more expensive than cisplatingemcitabine.
Meanwhile, taxane-based combinations are more expensive because they can only be administered in the hospital and tend to cause severe side effects that require additional treatment.
The cisplatin-paclitaxel regimen cost C9,043, higher than the C8,103 cost of cisplatin-gemcitabine.
Research by Pimentel et al.
,9 showed comparable results, namely cisplatingemcitabine provided an average cost savings per patient of C326 compared to cisplatin-docetaxel.
C1,201 compared to cisplatin-vincristine.
C1,717 compared to cisplatin-paclitaxel, and C2,925 compared to carboplatin-paclitaxel.
This study suspected that varying toxicity profiles could cause differences in hospitalization costs for each regimen.
Cisplatin-gemcitabine is known to have a higher number of hospitalizations due to toxicity, but it is still chosen as a costeffective treatment.
Neymark et al.
,10 conducted a costeffectiveness analysis of three regimens and found that cisplatin-gemcitabine was potentially more cost-effective than cisplatin-paclitaxel, with a cost difference of C765.
Meanwhile, other regimens such as paclitaxel-gemcitabine were much more expensive and less effective than cisplatin-paclitaxel.
9 A study by Schiller et al.
,11 also showed similar results, where cisplatin-gemcitabine was the most cost- Lintasari GA.
Comparative analysis of the treatment.
effective regimen compared to other paclitaxel-containing regimens in most countries, especially when administered as an outpatient.
These lower costs were primarily due to the lower drug price and lower frequency of administration.
A study conducted by Lees et 13 compared gemcitabine both as monotherapy and in combination with cisplatin.
Although the costs of gemcitabine monotherapy were higher than best supportive care (BSC), the cisplatin-gemcitabine regimen remained more cost-effective than taxane-based In a randomized controlled trial, cost was also a consideration in therapy selection.
The treatment costs and total hospitalization costs incurred using the cisplatin-gemcitabine regimen (A5,.
compared to other regimens, particularly cisplatin-paclitaxel (A9,.
Research by Yildirim et al.
,7 in Turkiye showed results that were inversely proportional to previous The treatment cost for 3 cycles of therapy with gemcitabine-cisplatin on an average body surface area was 3,246.
66 TL.
The cost of the paclitaxelcisplatin combination was 2,905.
92 TL,
while the cost of the docetaxel-cisplatin combination was 3,885.
12 TL.
Therefore, in terms of cost, the taxane combination was the cheapest compared to cisplatingemcitabine.
This is likely because this study only analyzed the cost of chemotherapy without considering the costs of other treatments, resulting in the higher cost of the cisplatin-gemcitabine The cost differences between cisplatin-gemcitabine and cisplatinpaclitaxel regimens found in most studies may be influenced by various factors.
Cisplatin-gemcitabine generally has different dosing patterns and potential side effects that may influence the need for additional treatment, thus impacting the total cost of therapy.
Furthermore, variations in results between studies may also be influenced by differences in cost analysis methods, calculated cost components, and the context of the healthcare system in each country.
Contextual factors such as drug pricing policies, health insurance systems, and local clinical practices also play a significant role in determining the total cost of therapy, so interpretation of the results cannot be separated from the context of each country.
The currency variations used in the analyzed studies were not standardized to a single currency.
This is because the focus of this review was to compare the relative costs of two regimens in each study context, rather than to conduct cross-country cost comparisons.
Therefore, interpretation of the results was based on differences in healthcare financing systems and cost structures across studies.
Clinical effectiveness in the context of cost analysis The clinical efficacy of cisplatinpaclitaxel and cisplatin-gemcitabine regimens in the treatment of advanced NSCLC was a consideration in selecting a pharmacoeconomic study design, specifically a cost-minimization analysis, in several studies reviewed in this article.
Most articles assessed that both regimens had comparable clinical outcomes, so the comparison focused on cost-efficiency.
In a study conducted by Schiller et al.
,11 the disease progression time resulting from the use of cisplatingemcitabine was longer, namely 4.
months compared to cisplatin-paclitaxel which was only 3.
4 months.
Meanwhile, a study by Smit et al.
,12 reported that the overall survival (OS) values of the two regimens were not significantly different, 9 months in the cisplatingemcitabine regimen and 8.
1 months in the cisplatin-paclitaxel regimen.
Although the resulting difference was not very significant, this still places cisplatin-gemcitabine as a more effective therapeutic option.
The results of the study by Yildirim et al.
,7 differed slightly from the two IJPTher.
Volume 7.
Number 2, 2026.
previous studies, namely the median OS values of the two regimens were quite different.
The taxane-based group, namely cisplatin-docetaxel and cisplatinpaclitaxel, had a higher median OS value of 14 months, while the cisplatingemcitabine regimen only reached 8.
However, the incidence of side effects caused by the taxane group was higher than that of cisplatin-gemcitabine, making this regimen superior in terms of safety.
Other clinical outcomes such as median survival and response to therapy were also examined in several studies reviewed in this article.
Neymark et 10 reported that cisplatin-gemcitabine provided a slightly higher survival .
compared to cisplatin-paclitaxel .
94 year.
Meanwhile, the response to therapy given cisplatin-gemcitabine .
%) was equivalent to cisplatinpaclitaxel .
3%).
Although differences in clinical outcomes between the two regimens, cisplatin-gemcitabine cisplatin-paclitaxel.
Therefore, both regimens are considered to be comparable in effectiveness, requiring consideration of other aspects such as cost, safety, and individual patient characteristics when selecting Implications for the health system in Seven articles in this review showed that the combination of cisplatinpaclitaxel and cisplatin-gemcitabine produced comparable clinical outcomes, while the costs were inversely related.
Not all studies yielded consistent results, likely due to variability in patient characteristics and healthcare systems in each country.
Therefore, these results may not be relevant to the Indonesian patient population.
Response to chemotherapy is influenced by genetic factors, so each individual can respond differently to the same treatment.
Because genetic variation is strongly influenced by ethnic background, the response of Indonesian patients to chemotherapy may differ from that of patients from other Several studies have shown that genetic variations that influence the effectiveness of chemotherapy abroad do not have the same effect on Indonesian This is likely due to the genetic diversity of the Indonesian population, so it is important to conduct research in local populations to determine differences in effectiveness.
The accuracy of therapy selection affects the treatment costs borne by both patients and the government through the National Health Insurance (JKN).
therapy is inappropriate, treatment costs can increase, and public trust in health services can decrease.
15 In the JKN system, therapies that can provide equivalent or better clinical outcomes but at a lower cost can be an option to provide more patients with access to treatment.
Furthermore, therapy decisions are also influenced by the national e-catalog and hospital formulary, which can sometimes limit choices if the drug is not regularly available.
Based on the results of a review of several articles, cisplatingemcitabine is more flexible in its administration because it can be given as an outpatient or even with home care services, depending on local systems and The findings of this review suggest that cisplatin-gemcitabine may be a more economically viable therapeutic option than cisplatin-paclitaxel.
These results can be used in clinical decision-making, particularly in healthcare financing systems like the National Health Insurance (JKN) in Indonesia.
However, the choice of therapy must still consider other factors such as drug availability, the patientAos clinical condition, potential side effects, and local healthcare system
STRENGTH AND LIMITATION
The main strength of this study Lintasari GA.
Comparative analysis of the treatment.
lies in its comprehensive approach regimens through the integration of pharmacoeconomic aspects and clinical outcomes from various study types.
The use of multiple databases increased the scope of the analyzed literature, while the focus on regimens commonly used in clinical practice provided high relevance for the application of the study Furthermore, the findings of this review have the potential to contribute to supporting cost-effectiveness-based decision-making in healthcare systems.
This narrative review has several It is not a systematic review, so the article selection process did not follow the PRISMA-based selection process, and potential selection bias is The cost data reported in each article originates from various countries with different healthcare systems and financing, so direct generalization of the results to the Indonesian system will be limited and require adjustment.
The articles included in this review are limited to older publication years because more recent studies have focused on targeted therapy and immunotherapy.
Differences in currency, publication year, and calculated cost components may also affect the comparability of the The clinical outcomes studied in each article are not completely identical, and not all articles present complete clinical outcome data.
Therefore, the interpretation of effectiveness in this review is carried out descriptively.
cost-effective alternative healthcare settings.
ACKNOWLEDGMENT
The author would like to thank the Faculty of Pharmacy.
Gadjah Mada University, for the knowledge and facilities provided, enabling the successful preparation of this manuscript.
The author also thanks those who assisted in writing this narrative review.
REFERENCES