Cancer Management and Research (Dec 2019)
Cost-Effectiveness Analysis Of EGFR Mutation Testing And Afatinib Versus Gemcitabine-Cisplatin As First-Line Therapy For Advanced Non-Small-Cell Lung Cancer In China
Abstract
Ruxu You,1,* Jinyu Liu,2,* David Bin-Chia Wu,3 XinYu Qian,4 Boxiang Lyu,5 Yu Zhang,1 Nan Luo4 1Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 2Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 3School of Pharmacy, Monash University Malaysia, Kuala Selangor, Malaysia; 4Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; 5Machine Learning Department, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA*These authors contributed equally to this workCorrespondence: Nan LuoSaw Swee Hock School of Public Health, National University of Singapore, 16 Medical Drive, Block MD3, Singapore 117597, SingaporeTel +65 6516 4966 Ext 188Fax +65 6779 1489Email [email protected]: The purpose of this study was to evaluate the cost-effectiveness of the combined use of afatinib and epidermal growth factor receptor (EGFR) testing versus gemcitabine-cisplatin as the first-line treatment for patients with non-small cell lung cancer (NSCLC) in China.Methods: A decision-analytic model, based on clinical phase III trials, was developed to simulate patient transitions. Direct costs were estimated from the perspective of the Chinese healthcare system. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER) were calculated over a 5-year lifetime horizon. Model robustness was conducted in sensitivity analyses.Results: For the base case, EGFR mutation testing followed by afatinib treatment for advanced NSCLC increased 0.15 QALYs compared with standard chemotherapy at an additional cost of $5069.12. The ICER for afatinib maintenance was $33,416.39 per QALY gained. The utility of PFS and the cost of afatinib had the most important impact on the ICER. Scenario analyses suggested that when a patient assistance program (PAP) was available, ICER decreased to $22,972.52/QALY lower than the willingness-to-pay (WTP) threshold of China ($26,508/QALY).Conclusion: Our results suggest that gene-guided maintenance therapy with afatinib with the PAP might be a cost-effective treatment option compared with gemcitabine – cisplatin in China.Keywords: Economic analysis, incremental cost-effectiveness ratio, NSCLC, EGER mutation testing, Afatinib
