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 Pub Date : 2020-02-01 Epub Date: 2019-09-20 DOI:10.1007/s10198-019-01117-3

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

{"title":"Cost-effectiveness analysis of the first-line EGFR-TKIs in patients with non-small cell lung cancer harbouring EGFR mutations.","authors":"Marscha S Holleman, Maiwenn J Al, Remziye Zaim, Harry J M Groen, Carin A Uyl-de Groot","doi":"10.1007/s10198-019-01117-3","DOIUrl":null,"url":null,"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.","PeriodicalId":22450,"journal":{"name":"The European Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058671/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The European Journal of Health Economics","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s10198-019-01117-3","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2019/9/20 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

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.

查看原文本刊更多论文

对携带表皮生长因子受体突变的非小细胞肺癌患者的一线表皮生长因子受体-TKIs进行成本效益分析。

研究目的比较一线吉非替尼、厄洛替尼、阿法替尼和奥西莫替尼治疗表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者的成本效益：通过系统综述和网络荟萃分析（NMA），比较吉非替尼、厄洛替尼、阿法替尼和奥西莫替尼对表皮生长因子受体突变的NSCLC的相对疗效。为了评估这些治疗方法的成本效益，我们从荷兰社会的角度建立了一个马尔可夫模型。该模型基于纳入 NMA 的临床研究。估算了每个生命年（LY）和每个质量调整生命年（QALY）的增量成本。进行了确定性和概率敏感性分析（PSA）：吉非替尼、厄洛替尼、阿法替尼和奥西莫替尼的每位患者总贴现成本分别为65,889欧元、64,035欧元、69,418欧元和131,997欧元，每位患者的平均QALY分别为1.36、1.39、1.52和2.01。厄洛替尼优于吉非替尼。阿法替尼与厄洛替尼的增量成本分别为27,058欧元/LY和41,504欧元/QALY。与阿法替尼相比，奥希替尼的收益为91,726欧元/LY和128,343欧元/QALY。PSA 显示，在 80,000 欧元/QALY 临界值下，吉非替尼、厄洛替尼、阿法替尼和奥西莫替尼具有成本效益的概率分别为 13%、19%、43% 和 26%。奥希替尼的降价幅度需要达到30%，才能使奥希替尼在80,000欧元/QALY的阈值下具有成本效益：结论：与所有其他TKI相比，奥希替尼具有更好的疗效。结论：与所有其他 TKIs 相比，奥希替尼具有更好的疗效，但在荷兰的阈值为 80,000 欧元/QALY 时，奥希替尼似乎不具成本效益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

The European Journal of Health Economics

自引率

0.00%

发文量