Cost-effectiveness analysis of the first‐line EGFR‐TKIs in patients with advanced EGFR-mutated non-small-cell lung cancer

ABSTRACT

Aim

To evaluate the cost-effectiveness of first-line treatments, such as erlotinib, gefitinib, afatinib, dacomitinib, and osimertinib, for patients diagnosed with stage IIIB/IV NSCLC harboring EGFR mutations.

Materials & methods

A partitioned survival model was developed to estimate quality-adjusted life-year (QALY) and incremental cost-effectiveness ratio (ICER) from the perspective of the Spanish National Health System. Two Bayesian NMAs were performed independently, by using the polynomial fraction method to fit Kaplan–Meier curves for overall survival and progression-free survival. Deterministic and probabilistic sensitivity analyses were performed to evaluate the uncertainty.

Results

The ICER was calculated for the four first-line treatments by comparing them with gefitinib, and the ratios obtained were as follows: €166,416/QALY for osimertinib, €183,682/QALY for dacomitinib, €167,554/QALY for afatinib, €36,196/QALY for erlotinib. It was seen that patients who received osimertinib presented higher QALYs (0.49), followed by dacomitinib (0.33), afatinib (0.32), erlotinib (0.31), and gefitinib (0.28).

Conclusions

Gefitinib is the most cost-effective treatment. In terms of QALYs gained, Osimertinib was more effective than all other TKIs. Nevertheless, with a Spanish threshold of €24,000/QALY, the reduction in the acquisition cost of osimertinib will have to be greater than 70%, to obtain a cost-effectiveness alternative.

KEYWORDS:

• Cost-effectiveness
• egfr-mutated
• non-small cell lung cancer
• economic evaluation
• partitioned survival model
• erlotinib
• gefitinib
• dacomitinib
• afatinib
• osimertinib

Declaration of Interests

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.

Ethical conduct of research

Our study used mathematical modeling and was not an active clinical trial; therefore, no approval was required from the Institutional Research Ethics Board.

Author contributions

All the authors interpreted the data, read, and approved the final manuscript.

Supplementary Material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper is not funded.