A systematic review of economic evaluations of tyrosine kinase inhibitors for non-small cell lung cancer (NSCLC)

ABSTRACT

Introduction

Although tyrosine kinase inhibitors (TKIs) have improved the efficacy of treatment for non-small cell lung cancer (NSCLC), the accessibility of TKIs is limited due to high costs. Despite the critical role of the cost-effectiveness of TKIs on decision-making, no systematic reviews have compared the cost-effectiveness of comparable TKIs. Therefore, we systemically reviewed the economic evaluation studies on various TKIs for NSCLC.

Areas covered

We searched PubMed and the Cochran Library to identify the published economic evaluation studies of TKIs in NSCLC patients that were published by January 2022. All of the included studies (n = 38) evaluated the cost-effectiveness of epidermal growth factor receptor (EGFR)-TKIs (n = 29) or anaplastic lymphocyte kinase (ALK)-TKIs (n = 9). The cost-effectiveness results were reported as the incremental cost-effectiveness ratio per quality-adjusted life-year, except for three studies.

Expert opinion

We found that the economic evaluation studies of the first and second generation of EGFR-TKIs and ALK-TKIs varied by the country and study settings, such as comparator and input parameters. In 12 studies, osimertinib (EGFR-TKI) was not cost-effective compared to other first/second EGFR-TKIs, regardless of the study settings. More evidence can be provided about cost-effectiveness of the third-generation TKIs in future research.

KEYWORDS:

• Non-small cell lung cancer
• tyrosine kinase inhibitor
• economic evaluation
• cost-effectiveness analysis
• systematic review

Article highlights

• Tyrosine kinase inhibitors (TKIs) have improved efficacy and safety profiles in non-small cell lung cancer (NSCLC) treatment over generations.

• In particular, the cost-effectiveness between epidermal growth factor receptor (EGFR)-TKIs and anaplastic lymphocyte kinase (ALK)-TKIs has been widely studied.

• Cost-effectiveness of TKIs differed by study due to different unit costs, utility weights, and study settings (i.e. thresholds).

• Third-generation TKIs, osimertinib (EGFR-TKI) and lorlatinib (ALK-TKI), were not cost-effective compared to first/second TKIs in the included studies due to their high prices.

• As a first review of cost-effectiveness between TKIs for NSCLC, this study would help healthcare providers and patients choose optimal treatment options and help industries improve cost-effectiveness of the drugs.

• Future studies are recommended to examine the cost-effectiveness of TKIs used for NSCLC treatment other than EGFR- and ALK-TKIs.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

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Additional information

Funding

This paper was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant Number: HI19C1328).