Cost-Effectiveness Analysis of Gefitinib Alone and Combined with Chemotherapy as First-Line Treatment for Patients with Advanced Non-Small-Cell Lung Cancer

Figures & data

Figure 1 Schematics of the decision tree and the Markov state transition model.

Table 1 Key Model Input Parameter

Parameters	Values
Weibull survival model of OS of gefitinib	Scale=0.006 shape=1.298 r^2=0.984
Weibull survival model of OS of GCP	Scale=0.002 shape=1.486 r^2=0.987
Weibull survival model of PFS of gefitinib	Scale=0.0184 shape=1.397 r^2=0.979
Weibull survival model of PFS of GCP	Scale=0.008 shape=1.441 r^2=0.996
Probability (%) of SAEs (grade≥3)^a
Fatigue in GCP	4.1 (Range:3.1–5.1)
Fatigue in gefitinib	0
Diarrhea in GCP	4.1 (Range:3.1–5.1)
Diarrhea in gefitinib	1.2 (Range:0.9–1.5)
Neutropenia in GCP	31.2 (Range:23.4–39.0)
Neutropenia in gefitinib	0.6 (Range:0.5–0.8)
Rash in GCP	4.1(Range:3.1–5.1)
Rash in gefitinib	2.9 (Range:2.2–3.6)
Febrile neutropenia in GCP	2.9 (Range:2.2–3.6)
Febrile neutropenia in gefitinib	0

Note: ^aThe probability of severe adverse event with grade≥3.

Abbreviations: PFS, progression-free survival; OS, overall survival; GCP, gefitinib and carboplatin plus pemetrexed; SAE, severe adverse event.

Table 2 Base-Case Cost Estimates and Utilities

Parameters	Values	Distribution	Source
Gefitinib per day	6.43 (6.43–22.8)	Gamma	Fixed
Pemetrexed per 500mg	396 (391–1045)	Gamma	Fixed
Carboplatin per 100mg	9 (6.84–11.25)	Gamma	Fixed
Supportive care per cycle	359 (169–845)	Gamma	[^Citation18]
Salvage chemotherapy per cycle	1669 (2170–3029)	Gamma	[^Citation18]
Follow up per unit	59.2 (44.4–74)	Gamma	[^Citation18]
Palliative care in terminal per patient	2176 (845–5812)	Gamma	[^Citation18]
Cost of managing SAEs per event
Fatigue	110.3 (82.72–137.9)	Gamma	Estimate
Diarrhea	0.76 (0.57–0.95)	Gamma	Estimate
Neutropenia	17.2 (12.9–21.5)	Gamma	Estimate
Rash	0.9 (0.68–1.13)	Gamma	Estimate
Febrile neutropenia	330 (247.5–412.5)	Gamma	Estimate
Utilities
PFS	0.804 (0.536–0.883)	Beta	[^Citation18,Citation20]
PD	0.321 (0.05–0.473)	Beta	[^Citation18,Citation20]
Fatigue	−0.07 (−0.525 to −0.0875)	Beta	[^Citation20]
Diarrhea	−0.07 (−0.525 to −0.0875)	Beta	[^Citation20]
Neutropenia	−0.20 (−0.15 to −0.25)	Beta	[^Citation20]
Rash	−0.10 (−0.75 to −1.25)	Beta	[^Citation20]
Febrile neutropenia	−0.42 (−0.315 to −0.525)	Beta	[^Citation20]

Abbreviations: PD, progressed disease; PFS, progression-free survival; SAE, severe adverse event.

Table 3 Summary of Cost and Outcome Results from a Base-Case Analysis

Strategy	Cost	Incr Cost	QALY	Incr QALY	ICER
Gefitinib	62,882.83	NA	1.70	NA	NA
GCP	84509.30	21,626.48	1.93	0.23	95,135.50

Abbreviations: Incr QALY, incremental cost per QALY; QALY, quality-adjusted life-years; GCP, gefitinib and carboplatin plus pemetrexed.

Figure 2 Unidirectional sensitivity analysis tornado plot comparing the first-line gefitinib strategy with the gefitinib plus chemotherapy strategy in an entire population with EGFR mutations.

Figure 3 Cost-effectiveness acceptability curves for gefitinib alone versus the gefitinib combined with chemotherapy in China.

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