ObjectivesEpidermal growth factor receptor–tyrosine kinase inhibitors (EGFR-TKIs) are an established treatment for advanced non-small cell lung cancer (NSCLC) with EGFR mutation. According to published meta-analyses, no significant efficacy differences have been demonstrated between erlotinib and afatinib. However, the incidence of EGFR–TKI-related adverse events (AEs) was lower with erlotinib. This study compares the cost of management of the AEs associated with these two drugs from the perspective of the Spanish National Health System (NHS).MethodsThe frequency of AEs was established from a recently published meta-analysis. In Spain, the daily cost of both drugs can be considered similar; as a result, only the costs of management of the AEs were considered. Costs and resource utilization in the management of the AEs were estimated by a panel of Spanish oncologists and from studies previously carried out in Spain. A probabilistic analysis was performed based on a Monte Carlo simulation.ResultsThe model generated 1,000 simulations. The total cost per patient treated with erlotinib and afatinib was €657.44 and €1,272.15, respectively. With erlotinib, the cost per patient and per AE of grades ≤2 and ≥3 was €550.86 and €106.58, respectively, whereas the cost with afatinib was €980.63 and €291.52, respectively. The reduction in the number of AEs with erlotinib could avoid a mean cost for the NHS of €614.71 (95% CI: €342.57–881.29) per patient.ConclusionIn advanced EGFR mutation-positive NSCLC patients, first-line treatment with erlotinib could reduce health care costs for the NHS, due to a decrease in the AE rate compared with afatinib. In long-term treatments, the avoidance of complications and the lowering of costs associated with the management of AEs are relevant factors that contribute to the sustainability of the health system.

A429lowed up to review the management of adverse event(s). Results: A total of 226 radiation related adverse events were found during study period. Among the study subjects, majority of them received chemo-radiation (n= 126: 56%) than radiotherapy (n= 100: 44%) alone. Majority of events observed were Fatigue (n= 39: 17.2%), followed by Mucositis (n= 29: 12.8%), Pain (n= 23: 10.17%), Diarrhea (n= 23: 10.17%) and Gastritis (n= 22: 9.7%). Less common events were Proctalgia (n= 20:8.8%), Vomiting (n= 18: 7.9%), Burning micturition (n= 7: 3%), Dermatitis (n= 7:3%) and Pyrexia (n= 6: 2.6%). Majority of the vomiting (55%), dehydration (80%), proctalgia (65%), pyrexia (67%) and burning micturition (57%) were categorized as grade 1 and grade 2. Grade 3 and 4 events were observed as vomiting (17%), diarrhea (13%), fatigue (5%), gastritis (4.5%), proctalgia (5%) and mucositis (14%). Most of the grade 3 events or grade 4 events were reported in patients who received external radiation therapy and was on chemo-radiation therapy compare to who received other types of radiation therapy and was on radiation therapy alone. ConClusions: Adverse events were found more in patients who received external radiation therapy than other types of radiation therapy. Patients on radiation and chemo radiation therapy need to be carefully followed up to identify radiation related negative outcomes. Appropriate follow up and management of these events reduces patients' burden of cure .

Aim: To estimate management cost of NSCLC ALK+ patients with and without brain metastasis (BM), and to compare annual costs in patients treated with alectinib or crizotinib. Methods: Management cost/year (€ 2018) in patients with and without BM was estimated with disaggregated resource consumption provided by local oncologists, including medical visits, hospitalizations, diagnostic/laboratory tests, imaging techniques and surgical procedures. The comparison of costs/year with alectinib and crizotinib, considered the cumulative 12-month incidence of BM in ALEX trial (9.4 and 41.4%, respectively). Results: Management cost was €6173.42/patient-year without BM and €21,637.50/patient-year with BM. With alectinib, average cost/patient was lower than crizotinib (€4948.51/patient-year) Conclusion: Prevention of BM with alectinib may result in reductions of cost/year in the management of advanced ALK+ NSCLC.

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