Cost-effectiveness of gefitinib, icotinib, and pemetrexed-based chemotherapy as first-line treatments for advanced non-small cell lung cancer in China

Lü, Shun; Ye, Ming; Ding, Lieming; Tan, Fenlai; Fei, Jie; Wu, Bin

doi:10.18632/oncotarget.14310

Cited by 47 publications

(59 citation statements)

References 44 publications

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“…Most studies analyzed the cost-effectiveness of EGFR testing [25][26][27][28][29] or EGFR-TKI versus chemotherapy as first-line treatment [30][31][32][33][34]. Direct comparisons between different first-line EGFR-TKIs, however, have been performed less frequently.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors: Analysis of real-world data in a tertiary hospital in Taiwan

et al. 2020

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IntroductionComparison of the effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors (TKIs) would improve patients' clinical benefits and save costs. Using realworld data, this study attempted to directly compare the effectiveness and cost-effectiveness of first-line afatinib, erlotinib, and gefitinib. MethodsDuring May 2011-December 2017, all patients with non-small cell lung cancer (NSCLC) visiting a tertiary center were invited to fill out the EuroQol five-dimension (EQ-5D) questionnaires and World Health Organization Quality of Life, brief version (WHOQOL-BREF), and received follow-ups for survival and direct medical costs. A total of 379 patients with EGFR mutation-positive advanced NSCLC under first-line TKIs were enrolled for analysis. After propensity score matching for the patients receiving afatinib (n = 48), erlotinib (n = 48), and gefitinib (n = 96), we conducted the study from the payers' perspective with a lifelong time horizon. ResultsPatients receiving afatinib had the worst lifetime psychometric scores, whereas the differences in quality-adjusted life expectancy (QALE) were modest. Considering 3 treatments together, afatinib was dominated by erlotinib. Erlotinib had an incremental cost-effectiveness of US$17,960/life year and US$12,782/QALY compared with gefitinib. Acceptability curves showed that erlotinib had 58.6% and 78.9% probabilities of being cost-effective given a threshold of 1 Taiwanese per capita GDP per life year and QALY, respectively.

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Section: Discussionmentioning

confidence: 99%

Comparative effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors: Analysis of real-world data in a tertiary hospital in Taiwan

et al. 2020

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“…Other costs associated with managing advanced NSCLC, including the cost of mutation testing and biopsy, were estimated at $44,127 and $26,428. The cost of supportive care was $359 per cycle, and the cost of end‐of‐life care was $2,176; both were adopted from our previously published economic evaluations . All costs are presented in 2017 U.S. dollars.…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Osimertinib in Treating Newly Diagnosed, Advanced EGFR-Mutation-Positive Non-Small Cell Lung Cancer

Wu¹,

Zhang

et al. 2018

The Oncologist

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Background The objective of this study was to assess cost and effectiveness of osimertinib in treating newly diagnosed advanced non‐small cell lung cancer with an epidermal growth factor receptor (EGFR) mutation from a public payer's perspective in the U.S. and China. Materials and Methods Markov models were developed to compare three treatment strategies: first‐line use of osimertinib, first‐line use of the standard first‐generation EGFR‐tyrosine kinase inhibitor (EGFR‐TKI) followed by the second‐line use of osimertinib, and the standard first‐generation EGFR‐TKI therapy (standard care [SOC]). Clinical data, cost, and utility data were mainly derived from published literatures. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the incremental cost per quality‐adjusted life year (QALY) between the treatments. Results The resultant incremental cost per QALY gained for the first‐line osimertinib versus SOC was $312,903 in the U.S. and $41,512 in China. The incremental cost per QALY for the second‐line osimertinib versus SOC was $284,532 in the U.S. and $38,860 in China. The probability of the SOC strategy being cost‐effective is 1.0 if the willingness to pay threshold is below $150,000/QALY in the U.S. and below $30,000/QALY in China. Conclusion Osimertinib as first‐line treatment could gain more health benefits in comparison with standard EGFR‐TKIs or second‐line use of osimertinib. However, because of the high cost of treatment, the cost‐effectiveness analyses were not in favor of the first‐line use of osimertinib from a public payer's perspective in the U.S. and China. Implications for Practice Osimertinib as first‐line treatment yielded the greatest health outcomes but is not a cost‐effective strategy for lung cancer in the U.S. and China. The price of osimertinib has a substantial impact on economic outcomes.

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“…All these data are listed in Table 1. 16,[19][20][21][22][23][28][29][30][31][32] For dosage calculation in the United States and China, body surface area (BSA) and body weight of 1.84 m 2 , 71.4 kg and 1.72 m 2 , 65 kg were adopted respectively. [33][34][35]…”

Section: Health Care Resource Uses Costs and Utilitymentioning

confidence: 99%

Cost‐effectiveness analysis of pembrolizumab plus chemotherapy with PD‐L1 test for the first‐line treatment of NSCLC

et al. 2020

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Background Pembrolizumab (Pembro) in combination with chemotherapy has been approved for the treatment of pretreated advanced NSCLC in the United States and China for its significant efficacy. However, the cost‐effectiveness is unknown considering Pembro's high price. The impact of programmed death ligand 1 (PD‐L1) test on the cost‐effectiveness is also unknown. The current study assessed the cost‐effectiveness of combination therapy for nonsquamous NSCLC from the United States and China public payers’ perspective. Materials and Methods A literature‐based Markov model was conducted using KEYNOTE‐189 trial data to compare cost and quality‐adjusted life years (QALYs) of three treatment strategies for nonsquamous NSCLC: Pembro‐chemotherapy combination and chemotherapy strategy without PD‐L1 test, and treatment strategy according to their PD‐L1 status. Results In base case analysis, the combination strategy generated an additional 0.78 QALYs and 0.59 QALYs over chemotherapy in the United States and China respectively, resulting in an ICER of $132 392/QALY in the United States and $92 533/QALY in China. In the PD‐L1 ≥1% base case, the ICERs were $77 754/QALY and $56 768/QALY respectively in the United States and China for PD‐L1 test strategy. In the PD‐L1 ≥50% base case, the ICERs were $44 731/QALY and $34 388/QALY respectively in the United States and China for PD‐L1 test strategy. Lowering Pembro price can also partly decrease the ICERs. Conclusion Compared with chemotherapy, the combination strategy is not cost‐effective for the treatment of NSCLC in the American and Chinese health care system at WTP threshold of $100 000/QALY for the United States and $27 351/QALY for China. Using PD‐L1 test for patient selection and price reduction could improve the cost‐effective probabilities of immunotherapy for nonsquamous NSCLC.

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Cost-effectiveness of gefitinib, icotinib, and pemetrexed-based chemotherapy as first-line treatments for advanced non-small cell lung cancer in China

Cited by 47 publications

References 44 publications

Comparative effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors: Analysis of real-world data in a tertiary hospital in Taiwan

Comparative effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors: Analysis of real-world data in a tertiary hospital in Taiwan

Cost-Effectiveness of Osimertinib in Treating Newly Diagnosed, Advanced EGFR-Mutation-Positive Non-Small Cell Lung Cancer

Cost‐effectiveness analysis of pembrolizumab plus chemotherapy with PD‐L1 test for the first‐line treatment of NSCLC

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