Cost-Effectiveness of Erlotinib versus Docetaxel for Second-Line Treatment of Advanced Non-Small-Cell Lung Cancer in the United Kingdom

Lewis, Gavin; Peake, Michael; Aultman, R; Gyldmark, Marlene; Morlotti, L; Creeden, James; Orden, Margarita De La

doi:10.1177/147323001003800102

Cited by 40 publications

(52 citation statements)

References 30 publications

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“…Each health state describes the symptom burden of a disease and its functional impact. More recently, LEWIS et al [23] used the same method to establish health utilities for erlotinib therapy, based on data for 154 members of the UK general population, using the EuroQol EQ-5D instrument (www.euroqol.org/). We used the results of both studies to test the robustness of our model with varying utility values.…”

Section: Discussionmentioning

confidence: 99%

“…Total costs were US$37,000, 39,100 and 43,800 for erlotinib, docetaxel and pemetrexed, respectively, compared with J21,025, 16,005 and 15,210, respectively, in our study. A more recent costutility analysis compared erlotinib with docetaxel for second-line management of advanced NSCLC in the UK National Health Service [23]. The authors used a health-state transition model based on the two pivotal phase III studies of erlotinib versus best supportive care and docetaxel versus best supportive care, to estimate direct costs, QALY and the subsequent net monetary benefit.…”

Section: Discussionmentioning

confidence: 99%

“…Utilities were derived from community population-based studies of advanced NSCLC performed in the UK [23,24], and used the standard gamble interview and a visual-analogue scale to assess quality of life (table 2).…”

Section: Utilitiesmentioning

confidence: 99%

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Cost-effectiveness of three strategies for second-line erlotinib initiation in nonsmall-cell lung cancer: the ERMETIC study part 3

Borget¹,

Cadranel²,

Pignon³

et al. 2011

Eur Respir J

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Several clinical and biological parameters are known to influence the efficacy of second-line erlotinib therapy for nonsmall cell lung cancer (NSCLC), but their medico-economic impact has not been evaluated. The objective of this study was to compare the incremental costeffectiveness ratios of strategies for second-line erlotinib initiation in NSCLC: clinically guided initiation (nonsmoking females with adenocarcinoma received erlotinib; all other patients received docetaxel) and biologically guided selection (patients with epidermal growth factor receptor (EGFR) mutation received erlotinib; patients with wild-type EGFR or unknown status received docetaxel), compared with initiation with no patient selection (strategy reference).A Markov model was constructed. Outcomes (overall and progression-free survival), transition probabilities and direct medical costs (from the French third-party payer's perspective) were prospectively collected for individual patients treated with either erlotinib or docetaxel, from treatment initiation to disease progression. Published data were used to estimate utilities and post-progression costs. Sensitivity analyses were performed.The biologically and clinically guided strategies were both more efficient (incremental qualityadjusted life-yrs equal to 0.080 and 0.081, respectively) and less expensive (cost decrease equal to J5,020 and J5,815, respectively) than the no-selection strategy, and the biologically guided strategy was slightly less expensive than the clinically guided strategy. Sensitivity analyses confirmed the robustness of the results.The cost-effectiveness of second-line NSCLC treatment is improved when patients are selected on either clinical or biological grounds.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cost-effectiveness of three strategies for second-line erlotinib initiation in nonsmall-cell lung cancer: the ERMETIC study part 3

Borget¹,

Cadranel²,

Pignon³

et al. 2011

Eur Respir J

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“…Lewis et al compared erlotinib with docetaxel in a cost-utility study. Although the results were very similar, they tended to favor erlotinib [24]. The answer is very different according to whether or not the population is selected.…”

Section: Erlotinibmentioning

confidence: 71%

Treatment of lung cancer: will financial issues become a criterion of choice?

Vergnenègre¹,

Borget²,

Chouaïd³

2013

Expert Review of Pharmacoeconomics & Outcomes Research

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“…These papers were published between 2002 and 2013; seven papers 63,65,66,[68][69][70][71] were published from 2010 onwards. All of the papers described full EEs using cost minimisation analysis (n = 1 64 ), cost-effectiveness analysis (n = 6 65,67,69,70,72 ) and/or cost-utility analysis (n = 6 [63][64][65]68,71,73 ) techniques. All but one study 70 used cost per QALY gained or cost per LY gained as the measure of cost-effectiveness.…”

Section: Cost-effectiveness Review: Resultsmentioning

confidence: 99%

Erlotinib and gefitinib for treating non-small cell lung cancer that has progressed following prior chemotherapy (review of NICE technology appraisals 162 and 175): a systematic review and economic evaluation

Greenhalgh

Bagust

Boland

et al. 2015

Health Technol Assess

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BackgroundLung cancer is the second most diagnosed cancer in the UK. Over 70% of lung cancers are non-small cell lung cancers (NSCLCs). Patients with stage III or IV NSCLC may be offered treatment to improve survival, disease control and quality of life. One-third of these patients receive further treatment following disease progression; these treatments are the focus of this systematic review.ObjectivesTo appraise the clinical effectiveness and cost-effectiveness of erlotinib [Tarceva®, Roche (UK) Ltd] and gefitinib (IRESSA®, AstraZeneca) compared with each other, docetaxel or best supportive care (BSC) for the treatment of NSCLC after disease progression following prior chemotherapy. The effectiveness of treatment with gefitinib was considered only for patients with epidermal growth factor mutation-positive (EGFR M+) disease.Data sourcesFour electronic databases (EMBASE, MEDLINE, The Cochrane Library, PubMed) were searched for randomised controlled trials (RCTs) and economic evaluations. Manufacturers’ evidence submissions to the National Institute for Health and Care Excellence were also considered.Review methodsOutcomes for three distinct patient groups based on EGFR mutation status [EGFR M+, epidermal growth factor mutation negative (EGFR M–) and epidermal growth factor mutation status unknown (EGFR unknown)] were considered. Heterogeneity of the data precluded statistical analysis. A de novo economic model was developed to compare treatments (incremental cost per quality-adjusted life-year gained).ResultsTwelve trials were included in the review. The use of gefitinib was compared with chemotherapy (n = 6) or BSC (n = 1), and the use of erlotinib was compared with chemotherapy (n = 3) or BSC (n = 1). One trial compared the use of gefitinib with the use of erlotinib. No trials included solely EGFR M+ patients; all data were derived from retrospective subgroup analyses from six RCTs [Kim ST, Uhm JE, Lee J, Sun JM, Sohn I, Kim SW,et al.Randomized phase II study of gefitinib versus erlotinib in patients with advanced non-small cell lung cancer who failed previous chemotherapy.Lung Cancer2012;75:82–8, V-15-32, Tarceva In Treatment of Advanced NSCLC (TITAN), BR.21, IRESSA Survival Evaluation in Lung cancer (ISEL) and IRESSA NSCLC Trial Evaluating REsponse and Survival versus Taxotere (INTEREST)]. These limited data precluded conclusions regarding the clinical effectiveness of any treatment for EGFR M+ patients. For EGFR M– patients, data were derived from the TArceva Italian Lung Optimization tRial (TAILOR) trial and Docetaxel and Erlotinib Lung Cancer Trial (DELTA). Retrospective data were also derived from subgroup analyses of BR.21, Kimet al., TITAN, INTEREST and ISEL. The only statistically significant reported results were for progression-free survival (PFS) for TAILOR and DELTA, and favoured docetaxel over erlotinib [TAILOR hazard ratio (HR) 1.39, 95% confidence interval (CI) 1.06 to 1.82; DELTA HR 1.44, 95% CI 1.08 to 1.92]. In EGFR unknown patients, nine trials (INTEREST, IRESSA as Second-line Therapy in Advanced NSCLC – KoreA, Li, Second-line Indication of Gefitinib in NSCLC, V-15-32, ISEL, DELTA, TITAN and BR.21) reported overall survival data and only one (BR.21) reported a statistically significant result favouring the use of erlotinib over BSC (HR 0.7, 95% CI 0.58 to 0.85). For PFS, BR.21 favoured the use of erlotinib when compared with BSC (HR 0.61, 95% CI 0.51 to 0.74) and the use of gefitinib was favoured when compared with BSC (HR 0.82, 95% CI 0.73 to 0.92) in ISEL. Limitations in the clinical data precluded assessment of cost-effectiveness of treatments for an EGFR M+ population by the Assessment Group (AG). The AG’s economic model suggested that for the EGFR M– population, the use of erlotinib was not cost-effective compared with the use of docetaxel and compared with BSC. For EGFR unknown patients, the use of erlotinib was not cost-effective when compared with BSC.Conclusions/future workThe lack of clinical data available for distinct patient populations limited the conclusions of the assessment. Future trials should distinguish between patients with EGFR M+ and EGFR M– disease.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Cost-Effectiveness of Erlotinib versus Docetaxel for Second-Line Treatment of Advanced Non-Small-Cell Lung Cancer in the United Kingdom

Cited by 40 publications

References 30 publications

Cost-effectiveness of three strategies for second-line erlotinib initiation in nonsmall-cell lung cancer: the ERMETIC study part 3

Cost-effectiveness of three strategies for second-line erlotinib initiation in nonsmall-cell lung cancer: the ERMETIC study part 3

Treatment of lung cancer: will financial issues become a criterion of choice?

Erlotinib and gefitinib for treating non-small cell lung cancer that has progressed following prior chemotherapy (review of NICE technology appraisals 162 and 175): a systematic review and economic evaluation

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