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

Marscha S. Holleman (), Maiwenn J. Al, Remziye Zaim, Harry J. M. Groen and Carin A. Uyl- de Groot
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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

The European Journal of Health Economics, 2020, vol. 21, issue 1, No 12, 153-164

Abstract: 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.

Keywords: Cost-effectiveness analysis; Non-small cell lung cancer; EGFR-TKI; Gefitinib; Erlotinib; Afatinib; Osimertinib (search for similar items in EconPapers)
JEL-codes: C59 C69 I19 (search for similar items in EconPapers)
Date: 2020
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DOI: 10.1007/s10198-019-01117-3

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