Cost‐effectiveness analysis of first‐line treatments for advanced epidermal growth factor receptor‐mutant non‐small cell lung cancer patients

Abstract

Objectives Recent studies showed prolonged survival for advanced epidermal growth factor receptor (EGFR)‐mutant non‐small cell lung cancer (NSCLC) patients treated with both monotherapies and combined therapies. However, high costs limit clinical applications. Thus, we conducted this cost‐effectiveness analysis to explore an optimal first‐line treatment for advanced EGFR‐mutant NSCLC patients. Materials and Methods Survival data were extracted from six clinical trials, including ARCHER1050 (dacomitinib vs. gefitinib); FLAURA (osimertinib vs. gefitinib/erlotinib); JO25567 and NEJ026 (bevacizumab +erlotinib vs. erlotinib); NEJ009 (gefitinib +chemotherapy vs. gefitinib); and NCT02148380 (gefitinib +chemotherapy vs. gefitinib vs. chemotherapy) trials. Cost‐related data were obtained from hospitals and published literature. The effect parameter (quality‐adjusted life year [QALY]) was the reflection of both survival and utility. Incremental cost‐effectiveness ratio (ICER), average cost‐effectiveness ratio (ACER), and net benefit were calculated, and the willingness‐to‐pay (WTP) threshold was set at $30828/QALY from the perspective of the Chinese healthcare system. Sensitivity analysis was performed to explore the stability of results. Results We compared treatment groups with control groups in each trial. ICERs were $1897750.74/QALY (ARCHER1050), $416560.02/QALY (FLAURA), ‐$477607.48/QALY (JO25567), ‐$464326.66/QALY (NEJ026), ‐$277121.22/QALY (NEJ009), ‐$399360.94/QALY (gefitinib as comparison, NCT02148380), and ‐$170733.05/QALY (chemotherapy as comparison, NCT02148380). Moreover, ACER and net benefit showed that the combination of EGFR‐TKI with chemotherapy and osimertinib was of more economic benefit following first‐generation EGFR‐TKIs. Sensitivity analyses showed that the impact of utilities and monotherapy could be cost‐effective with a 50% cost reduction. Conclusion First‐generation EGFR‐TKI therapy remained the most cost‐effective treatment option for advanced EGFR‐mutant NSCLC patients. Our results could serve as both a reference for both clinical practice and the formulation of medical insurance reimbursement.

Cost-Effectiveness Analysis of Gefitinib Plus Chemotherapy versus Gefitinib Alone for Advanced Non-Small-Cell Lung Cancer with EGFR Mutations in China

“…From the economic point of view, the first-generation EGFR-TKIs were still a more economical treatment option for EGFR-mutated NSCLC in China. 32 The study had some limitations that are worth discussing. First, basic information was retrospectively collected from a phase III trial, and we used the Weibull distribution to extrapolate the results beyond the follow-up duration of the RCTs, which was not patient-level data in clinical practice.…”

“…From the economic point of view, the first-generation EGFR-TKIs were still a more economical treatment option for EGFR-mutated NSCLC in China. 32 …”

Cost-Effectiveness Analysis of Gefitinib Alone and Combined with Chemotherapy as First-Line Treatment for Patients with Advanced Non-Small-Cell Lung Cancer

“…A recent economic assessment 23 determined the cost-effectiveness of gefitinib or gefitinib combined with carboplatin and pemetrexed chemotherapy for first-line treatment in patients with advanced EGFR mutation-positive NSCLC in China. The study found that compared with gefitinib, gefitinib combined with a chemotherapy regimen had an incremental cost of $37,795.92, an incremental QALY of −0.14, and an ICER of −277,121.22/QALY.…”

Cost‐effectiveness of osimertinib versus placebo in resected EGFR‐mutated non‐small cell lung cancer in China

“… 30 Third, owing to the absence of local health data, the utility scores of this study were only available by reference to literature published abroad when the QALYs were compared between groups. 25 , 26 , 27 , 28 , 29 Whereas, different ethnocultural backgrounds lead to the different situations for each state. Thus, this study simulates the outcomes of disease, without considering the utility of the drug reaction.…”

“…Only direct healthy costs were analyzed in our model, consisting of the costs of drug acquisition and adverse event management. Study‐related treatment costs applied to the analysis are listed in Table 2 21,26–29 . The costs of all strategies were calculated on the basis of costs per month (30 days).…”