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Cost-effectiveness analysis of the first-line EGFR-TKIs in patients with non-small cell lung cancer harbouring EGFR mutations

Author

Listed:
  • Marscha S. Holleman

    (Erasmus University Rotterdam)

  • Maiwenn J. Al

    (Erasmus University Rotterdam)

  • Remziye Zaim

    (Erasmus University Rotterdam)

  • Harry J. M. Groen

    (University of Groningen and University Medical Center Groningen)

  • Carin A. Uyl-de Groot

    (Erasmus University Rotterdam)

Abstract

Objectives To compare the cost-effectiveness of first-line gefitinib, erlotinib, afatinib, and osimertinib in patients with non-small cell lung cancer (NSCLC) harbouring epidermal growth factor receptor (EGFR) mutations. Methods A systematic review and network meta-analysis (NMA) were conducted to compare the relative efficacy of gefitinib, erlotinib, afatinib, and osimertinib in EGFR-mutated NSCLC. To assess the cost-effectiveness of these treatments, a Markov model was developed from Dutch societal perspective. The model was based on the clinical studies included in the NMA. Incremental costs per life-year (LY) and per quality-adjusted life-year (QALY) gained were estimated. Deterministic and probabilistic sensitivity analyses (PSA) were conducted. Results Total discounted per patient costs for gefitinib, erlotinib, afatinib, and osimertinib were €65,889, €64,035, €69,418, and €131,997, and mean QALYs were 1.36, 1.39, 1.52, and 2.01 per patient, respectively. Erlotinib dominated gefitinib. Afatinib versus erlotinib yielded incremental costs of €27,058/LY and €41,504/QALY gained. Osimertinib resulted in €91,726/LY and €128,343/QALY gained compared to afatinib. PSA showed that gefitinib, erlotinib, afatinib, and osimertinib had 13%, 19%, 43%, and 26% probability to be cost-effective at a threshold of €80,000/QALY. A price reduction of osimertinib of 30% is required for osimertinib to be cost-effective at a threshold of €80,000/QALY. Conclusions Osimertinib has a better effectiveness compared to all other TKIs. However, at a Dutch threshold of €80,000/QALY, osimertinib appears not to be cost-effective.

Suggested Citation

  • Marscha S. Holleman & Maiwenn J. Al & Remziye Zaim & Harry J. M. Groen & Carin A. Uyl-de Groot, 2020. "Cost-effectiveness analysis of the first-line EGFR-TKIs in patients with non-small cell lung cancer harbouring EGFR mutations," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(1), pages 153-164, February.
    • Handle: RePEc:spr:eujhec:v:21:y:2020:i:1:d:10.1007_s10198-019-01117-3
    DOI: 10.1007/s10198-019-01117-3
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    References listed on IDEAS

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    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    2. Nicky J. Welton & Howard H. Z. Thom, 2015. "Value of Information," Medical Decision Making, , vol. 35(5), pages 564-566, July.
    3. Wenhua Liang & Xuan Wu & Wenfeng Fang & Yuanyuan Zhao & Yunpeng Yang & Zhihuang Hu & Cong Xue & Jing Zhang & Jianwei Zhang & Yuxiang Ma & Ting Zhou & Yue Yan & Xue Hou & Tao Qin & Xiaoxiao Dinglin & Y, 2014. "Network Meta-Analysis of Erlotinib, Gefitinib, Afatinib and Icotinib in Patients with Advanced Non-Small-Cell Lung Cancer Harboring EGFR Mutations," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-11, February.
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    More about this item

    Keywords

    Cost-effectiveness analysis; Non-small cell lung cancer; EGFR-TKI; Gefitinib; Erlotinib; Afatinib; Osimertinib;
    All these keywords.

    JEL classification:

    • I19 - Health, Education, and Welfare - - Health - - - Other
    • C59 - Mathematical and Quantitative Methods - - Econometric Modeling - - - Other
    • C69 - Mathematical and Quantitative Methods - - Mathematical Methods; Programming Models; Mathematical and Simulation Modeling - - - Other

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