A trial-based cost-effectiveness analysis of erlotinib alone versus platinum-based doublet chemotherapy as first-line therapy for Eastern Asian nonsquamous non-small-cell lung cancer

• Published in: PloS one 2013-03, Vol.8 (3), p.e55917
• Main Authors: Wang, Siying, Peng, Liubao, Li, Jianhe, Zeng, Xiaohui, Ouyang, Lihui, Tan, Chongqing, Lu, Qiong
• Format: Article
• Language: English
• Subjects: Analysis; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - economics; Cancer; Cancer therapies; Carboplatin; Carboplatin - administration & dosage; Carboplatin - economics; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - economics; Chemotherapy; Clinical trials; Cost analysis; Cost benefit analysis; Costs and Cost Analysis; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Deoxycytidine - economics; Economic aspects; Enzyme inhibitors; Epidermal growth factor; Epidermal growth factor receptors; Erlotinib; Erlotinib Hydrochloride; Far East; Female; Gemcitabine; Gene mutation; Genetic aspects; Health aspects; Health care; Health care costs; Health risks; Hospitals; Humans; Life expectancy; Lung cancer; Lung diseases; Lung Neoplasms - drug therapy; Lung Neoplasms - economics; Male; Markov chains; Markov processes; Mathematics; Medicine; Models, Economic; Mutation; Non-small cell lung cancer; Non-small cell lung carcinoma; Parameter estimation; Parameter sensitivity; Patients; Pharmaceutical sciences; Pharmacy; Platinum; Point mutation; Protein-tyrosine kinase; Public health; Quinazolines - administration & dosage; Quinazolines - economics; Science Policy; Sensitivity analysis; Small cell lung carcinoma; Social and Behavioral Sciences; Statistical analysis; Time Factors; Tyrosine
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0055917

Lung cancer, the most prevalent malignant cancer in the world, remains a serious threat to public health. Recently, a large number of studies have shown that an epidermoid growth factor receptor-tyrosine kinase inhibitor (EGFR TKI), Erlotinib, has significantly better efficacy and is better tolerated in advanced non-small cell lung cancer (NSCLC) patients with a positive EGFR gene mutation. However, access to this drug is severely limited in China due to its high acquisition cost. Therefore, we decided to conduct a study to compare cost-effectiveness between erlotinib monotherapy and carboplatin-gemcitabine (CG) combination therapy in patients with advanced EGFR mutation-positive NSCLC. A Markov model was developed from the perspective of the Chinese health care system to evaluate the cost-effectiveness of the two treatment strategies; this model was based on data from the OPTIMAL trial, which was undertaken at 22 centres in China. The 10-year quality-adjusted life years (QALYs), direct costs, and incremental cost-effectiveness ratio (ICER) were estimated. To allow for uncertainties within the parameters and to estimate the model robustness, one-way sensitivity analysis and probabilistic sensitivity analysis were performed. The median progression-free survival (PFS) obtained from Markov model was 13.2 months (13.1 months was reported in the trial) in the erlotinib group while and 4.64 months (4.6 months was reported in the trial) in the CG group. The QALYs were 1.4 years in the erlotinib group and 1.96 years in the CG group, indicating difference of 0.56 years. The ICER was most sensitive to the health utility of DP ranged from $58,584.57 to $336,404.2. At a threshold of $96,884, erlotinib had a 50% probability of being cost-effective. Erlotinib monotherapy is more cost-effective compared with platinum-based doublets chemotherapy as a first-line therapy for advanced EGFR mutation- positive NSCLC patients from within the Chinese health care system.