Cost-effectiveness analysis of tyrosine kinase inhibitors (erlotinib, gefitinib, afatinib and osimertinib) as first-line therapy for epidermal growth factor receptor-mutated advanced non-small cell lung cancer

doi:10.5246/jcps.2021.03.021

Abstract

Abstract:

Gefitinib, erlotinib, afatinib and osimertinib have been recommended as the first-line treatment for epidermal growth factor receptor (EGFR)-mutated advanced non-small cell lung cancer (NSCLC), whereas no studies have compared the cost-effectiveness of these four tyrosine kinase inhibitors (TKIs) simultaneously in China. In the present study, we aimed to estimate the cost-effectiveness of erlotinib, gefitinib, afatinib and osimertinib for untreated EGFR-mutated advanced NSCLC. A Markov model was constructed to compare the 10-year impact of four TKIs for patients with treatment-naive EGFR-mutated advanced NSCLC from the perspective of the Chinese medical system. Clinical data and utility values were derived from published literature, and costs were obtained from Chinese official websites. The primary output indicator was the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to test the robustness of the model. We found that afatinib was estimated to spend the lowest cost with minimum life-years (LYs), while osimertinib was the most expensive regimen with maximum LYs. The ICER of gefitinib versus afatinib was \$732/quality-adjusted life-year (QALY), which was less than the willingness-to-pay (WTP) of \$29 382/QALY. Compared with gefitinib, erlotinib yielded a higher cost and a shorter lifetime, hence it was identified as a dominated strategy. Then, osimertinib was compared to gefitinib, which produced an ICER of \$71 330/QALY, exceeding the WTP. It suggested that gefitinib was the most cost-effective regimen as the first-line treatment for EGFR-mutated advanced NSCLC. Decreasing the osimertinib price or increasing the WTP threshold to \$68 558/QALY might enhance the favorability of the outcome, by which osimertinib might become more cost-effective. One-way sensitivity analysis manifested that the model was robust.

Key words: Cost-effectiveness analysis, Markov model, Tyrosine kinase inhibitor, Non-small cell lung cancer, First-line therapy, Epidermal growth factor receptor

Supporting:

Shaohong Luo, Liangliang Dong, Yiyuan Li, Dan Xu, Min Chen. Cost-effectiveness analysis of tyrosine kinase inhibitors (erlotinib, gefitinib, afatinib and osimertinib) as first-line therapy for epidermal growth factor receptor-mutated advanced non-small cell lung cancer[J]. Journal of Chinese Pharmaceutical Sciences, 2021, 30(3): 253-263.

Figures/Tables 9

Table 1. Key clinical data inputted to model.

Table 2. Costs of drug and examinations.

Table 3. Utility values of different health states and probability of SAEs.

Table 4. Sensitivity analysis of parameter ranges and distribution.

Table 5. Summary of cost and outcome results.

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