Gene-guided Gefitinib switch maintenance therapy for patients with advanced EGFR mutation-positive Non-small cell lung cancer: an economic analysis

Abstract

BackgroundMaintenance therapy with gefitinib notably improves survival in patients with advanced non-small cell lung cancer (NSCLC) and EGFR mutation-positive tumors, but the economic impact of this practice is unclear.MethodsA decision-analytic model was developed to simulate 21-day patient transitions in a 10-year time horizon. The clinical data were primarily obtained from the results of a pivotal phase III trial that assessed gefitinib maintenance treatment in patients with advanced NSCLC. The cost data were derived from the perspective of the Chinese health care system. The primary outcome was the incremental cost-effectiveness ratio (ICER) at a willingness-to-pay (WTP) threshold of 3 times the per capita GDP of China. Sensitivity analyses were used to explore the impact of uncertainty regarding the results. The impact of the gefitinib patient assistance program (GPAP) was evaluated.ResultsAfter EGFR genotyping, gefitinib maintenance treatment for advanced NSCLC with EGFR mutations increased the life expectancy by 0.74 years and 0.46 QALYs compared with routine follow-up at an additional cost of $26,149.90 USD ($7,178.20 with the GPAP). The ICER for gefitinib maintenance was $57,066.40 and $15,664.80 per QALY gained (at a 3% discount rate) without and with the GPAP, respectively. The utility of progression free survival, the hazard ratio of progression-free survival for gefitinib treatment and the cost of gefitinib per dose were the three factors that had the greatest influence on the results.ConclusionsThese results indicate that gene-guided maintenance therapy with gefitinib with the GPAP might be a cost-effective treatment option.

Nivolumab Versus Docetaxel for Previously Treated Advanced Non-Small Cell Lung Cancer in China: A Cost-Effectiveness Analysis

“…It should be noted that, the utility of PFS played an important role in the model, and similar findings have been reported in previous studies [19,29]. A new study on the utilities of NSCLC from six countries including China conducted by Nafees et al, showed that some common toxicities associated with treatment probably lead to a significant decline in the utility of PFS [20].…”

Cost-Effectiveness of an Individualized First-Line Treatment Strategy Offering Erlotinib Based on EGFR Mutation Testing in Advanced Lung Adenocarcinoma Patients in Germany

“…To our knowledge, there are five studies assessing the cost-effectiveness of individualized EGFR-TKI therapy either in the context of first-line [13,15], maintenance [37] or second-line therapy [14,26]. In the study by de Lima Lopes et al [13], an individualized strategy with gefitinib was found to be dominant compared with a non-individualized strategy from the perspective of three Singapore cancer centers.…”

Economic Outcomes of Maintenance Gefitinib for Locally Advanced/Metastatic Non-Small-Cell Lung Cancer with Unknown EGFR Mutations: A Semi-Markov Model Analysis

“…Several economic studies were conducted of maintenance therapy [16]–[23]. Two analyses concluded that maintenance erlotinib is cost-effective versus best supportive care for locally advanced/metastatic NSCLC [16], [17].…”