Real-World EQ5D Health Utility Scores for Patients With Metastatic Lung Cancer by Molecular Alteration and Response to Therapy

Labbé, Catherine; Leung, Yvonne; Lemes, João Gabriel Silva; Stewart, Erin; Brown, Catherine; Cosio, Andrea Perez; Doherty, Mark; O’Kane, Grainne M.; Patel, Devalben; Cheng, Nicholas; Liang, Mindy; Gill, Gursharan; Rett, Alexandra; Naik, Hiten; Eng, Lawson; Mittmann, Nicole; Bradbury, Penelope Ann; Shepherd, Frances A.; Xu, Wei; Liu, Geoffrey; Howell, Doris

doi:10.1016/j.cllc.2016.12.015

Cited by 23 publications

(27 citation statements)

References 22 publications

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“…Univariable and multivariable analyses are presented in Table ; mHUS by histo‐molecular subtype and BM status is presented in supplemental online Table 2. Patients with EGFR m or ALK r had overall higher mHUS compared with other patients with NSCLC and SCLC, confirming previous reports .…”

Section: Resultssupporting

confidence: 89%

“…Clinical data were extracted from medical records as previously reported . At first diagnosis, computed tomography (CT) imaging of the thorax and abdomen and brain imaging (typically MRI brain) were standard.…”

Section: Methodsmentioning

confidence: 99%

“…The EQ‐5D‐3L is one of the most commonly used HUS tools in patients with cancer, with specific Canadian values reported . Although we have presented HUS results in patients with advanced lung cancer , HUS in patients with lung cancer specifically with BM have not been reported. This study aims to evaluate the impact of BM on HUS in lung cancer patients, enriched for EGFR m and ALKr .…”

Section: Introductionmentioning

confidence: 93%

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The Impact of Brain Metastases and Associated Neurocognitive Aspects on Health Utility Scores in EGFR Mutated and ALK Rearranged NSCLC: A Real World Evidence Analysis

O’Kane

Tse

et al. 2019

The Oncologist

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Background In lung cancer, brain metastases (BM) and their treatment are associated with high economic burden and inferior health‐related quality of life. In the era of targeted therapy, real world evidence through health utility scores (HUS) is critical for economic analyses. Materials and Methods In a prospective observational cohort study (2014–2016), outpatients with stage IV lung cancer completed demographic and EQ‐5D‐3L surveys (to derive HUS). Health states and clinicopathologic variables were obtained from chart abstraction. Patients were categorized by the presence or absence of BM; regression analyses identified factors that were associated with HUS. A subset of patients prospectively completed neurocognitive function (NCF) tests and/or the FACT‐brain (FACT‐Br) questionnaire, which were then correlated with HUS (Spearman coefficients; regression analyses). Results Of 519 patients with 1,686 EQ‐5D‐3L‐derived HUS, 94 (18%) completed NCF tests and 107 (21%) completed FACT‐Br; 301 (58%) never developed BM, 24 (5%) developed first BM during study period, and 194 (37%) had BM at study entry. The sample was enriched (46%) for EGFR mutations (EGFRm) and ALK‐rearrangements (ALKr). There were no HUS differences by BM status overall and in subsets by demographics. In multivariable analyses, superior HUS was associated with having EGFRm/ALKr (p < .0001), no prior radiation for extracranial disease (p < .001), and both intracranial (p = .002) and extracranial disease control (p < .01). HUS correlated with multiple elements of the FACT‐Br and tests of NCF. Conclusion Having BM in lung cancer is not associated with inferior HUS in a population enriched for EGFRm and ALKr. Patients exhibiting disease control and those with oncogene‐addicted tumors have superior HUS. Implications for Practice In the setting of EGFR mutations or ALK rearrangement non‐small cell lung cancer (NSCLC), a diagnosis of brain metastases no longer consigns the patient to an inferior health state suggesting that new economic analyses in NSCLC are needed in the era of targeted therapies. Additionally, the EQ‐5D questionnaire is associated with measures of health‐related quality of life and neurocognitive scores suggesting this tool should be further explored in prospective clinical studies.

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Section: Resultssupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

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The Impact of Brain Metastases and Associated Neurocognitive Aspects on Health Utility Scores in EGFR Mutated and ALK Rearranged NSCLC: A Real World Evidence Analysis

O’Kane

Tse

et al. 2019

The Oncologist

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“…When the health states of a general advanced NSCLC population were examined, commonly observed symptoms such as cough, dyspnea, and pain corresponded with a mean utility loss of 0.069 . Within an EGFR m‐specific population, poor appetite and fatigue have been associated with lower HUS . Furthermore, recent studies have demonstrated that treatment‐related adverse effects correlate with different quality of life across TKI agents; however, these data are limited to gefitinib, erlotinib, and afatinib .…”

Section: Introductionmentioning

confidence: 99%

“…26 Within an EGFRmspecific population, poor appetite and fatigue have been associated with lower HUS. 27 Furthermore, recent studies have demonstrated that treatment-related adverse effects correlate with different quality of life across TKI agents; however, these data are limited to gefitinib, erlotinib, and afatinib. 29,30 While there have been new advances in EGFRm treatments and it has been shown that different treatments have implications on HUS, there remains limited data on the impact of treatment and toxicities in an EGFRm population.…”

Section: Introductionmentioning

confidence: 99%

Real‐world health utility scores and toxicities to tyrosine kinase inhibitors in epidermal growth factor receptor mutated advanced non‐small cell lung cancer

et al. 2019

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Background As the treatment landscape in patients with non‐small cell lung cancer (NSCLC) harboring mutations in the epidermal growth factor receptor (EGFRm) continues to evolve, real‐world health utility scores (HUS) become increasingly important for economic analyses. Methods In an observational cohort study, questionnaires were completed in EGFRm NSCLC outpatients, to include demographics, EQ‐5D‐based HUS and patient‐reported toxicity and symptoms. Clinical and radiologic characteristics together with outcomes were extracted from chart review. The impact of health states, treatment type, toxicities, and clinical variables on HUS were evaluated. Results Between 2014 and 2018, a total of 260 patients completed 994 encounters. Across treatment groups, patients with disease progression had lower HUS compared to controlled disease (0.771 vs 0.803; P = .01). Patients predominantly received gefitinib as the first‐line EGFR tyrosine kinase inhibitor (TKI) (n = 157, mean‐HUS = 0.798), whereas osimertinib (n = 62, mean‐HUS = 0.806) and chemotherapy (n = 38, mean‐HUS = 0.721) were more likely used in subsequent treatment lines. In longitudinal analysis, TKIs retained high HUS (>0.78) compared to chemotherapy (HUS < 0.74). There were no differences between the frequency or severity of toxicity scores in patients receiving gefitinib compared to osimertinib; however, TKI therapy resulted in fewer toxicities than chemotherapy (P < .05), with the exception of worse diarrhea and skin rash (P < .001). Severity in toxicities inversely correlated with HUS (P < .001). Clinico‐demographic factors significantly affecting HUS included age, Eastern Cooperative Oncology Group Performance Score (ECOG PS), disease state, treatment group, and metastatic burden. Conclusions In a real‐world EGFRm population, patients treated with gefitinib or osimertinib had similar HUS and toxicities, scores which were superior to chemotherapy. Health utility scores inversely correlated with patient‐reported toxicity scores. In the era of targeted therapies, future economic analyses should incorporate real‐world HUS.

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

Chai

et al. 2021

Cancer Medicine

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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.

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Real-World EQ5D Health Utility Scores for Patients With Metastatic Lung Cancer by Molecular Alteration and Response to Therapy

Cited by 23 publications

References 22 publications

The Impact of Brain Metastases and Associated Neurocognitive Aspects on Health Utility Scores in EGFR Mutated and ALK Rearranged NSCLC: A Real World Evidence Analysis

The Impact of Brain Metastases and Associated Neurocognitive Aspects on Health Utility Scores in EGFR Mutated and ALK Rearranged NSCLC: A Real World Evidence Analysis

Real‐world health utility scores and toxicities to tyrosine kinase inhibitors in epidermal growth factor receptor mutated advanced non‐small cell lung cancer

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

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