Economic Evaluation of the Use of Gefitinib for the Treatment of Locally Advanced or Metastatic NSCLC

Abstract

Objectives: To conduct a cost-effectiveness analysis of panitumumab plus mFOL-FOX6 versus bevacizumab plus mFOLFOX6 as first-line treatment (FLT) of metastatic colorectal cancer (mCRC) patients with wild-type RASin the Greek health care setting. MethOds: An existing Markov model consisting of seven health states was adapted from the public third-party-payer perspective. Both efficacy and safety data considered in the model were extracted from the PEAK trial and other published studies. Utility values were also extracted from the literature. Direct medical costs consisting of drug-acquisition costs for FLT, administration costs, subsequent therapy costs and other medical costs were incorporated into the model and reflect the year 2014. Primary outcomes were patient survival (life-years), quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) per QALY gained. Probabilistic sensitivity analysis (PSA) was conducted to account for uncertainty and variation in the parameters of the model. Results: The analysis showed that panitumumab plus mFOLFOX6 produced greater discounted survival and quality adjusted survival by 0.87 LYs and 0.65 QALY benefit in relation to bevacizumab plus mFOLFOX6. The total lifetime cost was € 75,200 and € 52,736 for panitumumab and bevacizumab plus mFOLFOX6, respectively. This difference was mainly attributed to the higher acquisition cost of panitumumab compared to bevacizumab during the pre-progression health state (€ 32,223 and € 14,730 respectively). Incremental analysis showed that panitumumab plus mFOLFOX6 was more effective and more costly than bevacizumab plus mFOLFOX6 resulting in an ICER equal to € 34,644 per QALY gained. PSA revealed that the probability of panitumumab plus mFOL-FOX6 being cost-effective over bevacizumab plus mFOLFOX6 was 81.5% at the predetermined threshold of € 51,000 per QALY gained (3 times the GDP per capita of Greece). cOnclusiOns: The results suggest that panitumumab plus mFOLFOX6 may be a cost-effective alternative relative to bevacizumab plus mFOLFOX6 as FLT of mCRC patients with wild-type RASin Greece.