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A Trial-Based Cost-Effectiveness Analysis of Erlotinib Alone versus Platinum-Based Doublet Chemotherapy as First-Line Therapy for Eastern Asian Nonsquamous Non–Small-Cell Lung Cancer

Author

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  • Siying Wang
  • Liubao Peng
  • Jianhe Li
  • Xiaohui Zeng
  • Lihui Ouyang
  • Chongqing Tan
  • Qiong Lu

Abstract

Introduction: Lung cancer, the most prevalent malignant cancer in the world, remains a serious threat to public health. Recently, a large number of studies have shown that an epidermoid growth factor receptor-tyrosine kinase inhibitor (EGFR TKI), Erlotinib, has significantly better efficacy and is better tolerated in advanced non-small cell lung cancer (NSCLC) patients with a positive EGFR gene mutation. However, access to this drug is severely limited in China due to its high acquisition cost. Therefore, we decided to conduct a study to compare cost-effectiveness between erlotinib monotherapy and carboplatin-gemcitabine (CG) combination therapy in patients with advanced EGFR mutation-positive NSCLC. Methods: A Markov model was developed from the perspective of the Chinese health care system to evaluate the cost-effectiveness of the two treatment strategies; this model was based on data from the OPTIMAL trial, which was undertaken at 22 centres in China. The 10-year quality-adjusted life years (QALYs), direct costs, and incremental cost-effectiveness ratio (ICER) were estimated. To allow for uncertainties within the parameters and to estimate the model robustness, one-way sensitivity analysis and probabilistic sensitivity analysis were performed. Results: The median progression-free survival (PFS) obtained from Markov model was 13.2 months (13.1 months was reported in the trial) in the erlotinib group while and 4.64 months (4.6 months was reported in the trial) in the CG group. The QALYs were 1.4 years in the erlotinib group and 1.96 years in the CG group, indicating difference of 0.56 years. The ICER was most sensitive to the health utility of DP ranged from $58,584.57 to $336,404.2. At a threshold of $96,884, erlotinib had a 50%probability of being cost-effective. Conclusions: Erlotinib monotherapy is more cost-effective compared with platinum-based doublets chemotherapy as a first-line therapy for advanced EGFR mutation- positive NSCLC patients from within the Chinese health care system.

Suggested Citation

  • Siying Wang & Liubao Peng & Jianhe Li & Xiaohui Zeng & Lihui Ouyang & Chongqing Tan & Qiong Lu, 2013. "A Trial-Based Cost-Effectiveness Analysis of Erlotinib Alone versus Platinum-Based Doublet Chemotherapy as First-Line Therapy for Eastern Asian Nonsquamous Non–Small-Cell Lung Cancer," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-9, March.
    • Handle: RePEc:plo:pone00:0055917
    DOI: 10.1371/journal.pone.0055917
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    References listed on IDEAS

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    1. Xiaohui Zeng & Jonathan Karnon & Siying Wang & Bin Wu & Xiaomin Wan & Liubao Peng, 2012. "The Cost of Treating Advanced Non-Small Cell Lung Cancer: Estimates from the Chinese Experience," PLOS ONE, Public Library of Science, vol. 7(10), pages 1-7, October.
    2. Christopher J.L. Murray & David B. Evans & Arnab Acharya & Rob M.P.M. Baltussen, 2000. "Development of WHO guidelines on generalized cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 9(3), pages 235-251, April.
    3. Mathilda Bongers & Veerle Coupé & Elise Jansma & Egbert Smit & Carin Groot, 2012. "Cost Effectiveness of Treatment with New Agents in Advanced Non-Small-Cell Lung Cancer," PharmacoEconomics, Springer, vol. 30(1), pages 17-34, January.
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    1. Cuc Thi Thu Nguyen & Fabio Petrelli & Stefania Scuri & Binh Thanh Nguyen & Iolanda Grappasonni, 2019. "A systematic review of pharmacoeconomic evaluations of erlotinib in the first-line treatment of advanced non-small cell lung cancer," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(5), pages 763-777, July.
    2. Oscar Arrieta & Pablo Anaya & Vicente Morales-Oyarvide & Laura Alejandra Ramírez-Tirado & Ana C. Polanco, 2016. "Cost-effectiveness analysis of EGFR mutation testing in patients with non-small cell lung cancer (NSCLC) with gefitinib or carboplatin–paclitaxel," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(7), pages 855-863, September.
    3. Eun-A Lim & Haeyoung Lee & Eunmi Bae & Jaeok Lim & Young Kee Shin & Sang-Eun Choi, 2016. "Economic Evaluation of Companion Diagnostic Testing for EGFR Mutations and First-Line Targeted Therapy in Advanced Non-Small Cell Lung Cancer Patients in South Korea," PLOS ONE, Public Library of Science, vol. 11(8), pages 1-14, August.
    4. Chunxiang Zhang & Hongmei Zhang & Jinning Shi & Dong Wang & Xiuwei Zhang & Jian Yang & Qizhi Zhai & Aixia Ma, 2016. "Trial-Based Cost-Utility Analysis of Icotinib versus Gefitinib as Second-Line Therapy for Advanced Non-Small Cell Lung Cancer in China," PLOS ONE, Public Library of Science, vol. 11(3), pages 1-10, March.

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