Incremental cost-effectiveness analysis of tyrosine kinase inhibitors in advanced non-small cell lung cancer with mutations of the epidermal growth factor receptor in Colombia

ABSTRACT

Objective

To estimate the cost-effectiveness of sequences starting with tyrosine kinase inhibitors (TKI), afatinib and osimertinib, for the treatment of epidermal growth factor receptor (EGFR) mutation-positive (Exon 19 deletion or L858R) non-small cell lung cancer (NSCLC), stages IIIB – IV in Colombia.

Methods

A partitioned survival model was designed, using information from global and progression-free survival curves. For first and second-generation TKI, second line treatment was assumed according to the presence of T790M mutation to define the use of osimertinib or chemotherapy. The cost of the states without progression and post-progression was estimated using the base case approach, identified through consultation with clinical experts.

Results

The cost of treatment starting with afatinib in the first line was of 222,247 USD (1 USD = 3171.99 COP) and produced 1.36 QALYs. The strategy with afatinib was dominant with respect to that of first line TKI (227,289 USD and 1.34 QALY). The strategy with osimertinib resulted in more QALYs and higher costs, with ICERs of 35,062 USD, exceeding the current willingness to pay threshold for Colombia.

Conclusions

Treatment starting with afatinib in the first line is dominant with respect to the strategy with first line TKI. The ICER of osimertinib sequence exceeds the threshold when compared with afatinib one.

KEYWORDS:

• Afatinib
• gefitinib
• erlotinib
• bevacizumab
• osimertinib
• cost-effectiveness
• lung cancer
• sequence

Declaration of interest

The authors have no other 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 apart from those disclosed.

Reviewers disclosure

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

Author’s contributions

PL, FH, YG and DR were responsible for designing and implementing the economic evaluation, data collection and, analysing and interpreting the results. All authors have been involved in drafting the manuscript or revising it critically and have given final approval to this version.

Ethical approval

This study does not perform an intervention on patients, and it does not either use individual personal data, therefore, it does not require ethical committee approval.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was funded by Boehringer Ingelheim Colombia