Cost‐effectiveness analysis of first‐line treatments for advanced epidermal growth factor receptor‐mutant non‐small cell lung cancer patients

Abstract Objectives Recent studies showed prolonged survival for advanced epidermal growth factor receptor (EGFR)‐mutant non‐small cell lung cancer (NSCLC) patients treated with both monotherapies and combined therapies. However, high costs limit clinical applications. Thus, we conducted this cost‐e...

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Main Authors: Wen‐Qian Li, Ling‐Yu Li, Jin Chai, Jiu‐Wei Cui
Format: Article
Language:English
Published: Wiley 2021-03-01
Series:Cancer Medicine
Subjects:
Online Access:https://doi.org/10.1002/cam4.3733
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author Wen‐Qian Li
Ling‐Yu Li
Jin Chai
Jiu‐Wei Cui
author_facet Wen‐Qian Li
Ling‐Yu Li
Jin Chai
Jiu‐Wei Cui
author_sort Wen‐Qian Li
collection DOAJ
description Abstract Objectives Recent studies showed prolonged survival for advanced epidermal growth factor receptor (EGFR)‐mutant non‐small cell lung cancer (NSCLC) patients treated with both monotherapies and combined therapies. However, high costs limit clinical applications. Thus, we conducted this cost‐effectiveness analysis to explore an optimal first‐line treatment for advanced EGFR‐mutant NSCLC patients. Materials and Methods Survival data were extracted from six clinical trials, including ARCHER1050 (dacomitinib vs. gefitinib); FLAURA (osimertinib vs. gefitinib/erlotinib); JO25567 and NEJ026 (bevacizumab +erlotinib vs. erlotinib); NEJ009 (gefitinib +chemotherapy vs. gefitinib); and NCT02148380 (gefitinib +chemotherapy vs. gefitinib vs. chemotherapy) trials. Cost‐related data were obtained from hospitals and published literature. The effect parameter (quality‐adjusted life year [QALY]) was the reflection of both survival and utility. Incremental cost‐effectiveness ratio (ICER), average cost‐effectiveness ratio (ACER), and net benefit were calculated, and the willingness‐to‐pay (WTP) threshold was set at $30828/QALY from the perspective of the Chinese healthcare system. Sensitivity analysis was performed to explore the stability of results. Results We compared treatment groups with control groups in each trial. ICERs were $1897750.74/QALY (ARCHER1050), $416560.02/QALY (FLAURA), ‐$477607.48/QALY (JO25567), ‐$464326.66/QALY (NEJ026), ‐$277121.22/QALY (NEJ009), ‐$399360.94/QALY (gefitinib as comparison, NCT02148380), and ‐$170733.05/QALY (chemotherapy as comparison, NCT02148380). Moreover, ACER and net benefit showed that the combination of EGFR‐TKI with chemotherapy and osimertinib was of more economic benefit following first‐generation EGFR‐TKIs. Sensitivity analyses showed that the impact of utilities and monotherapy could be cost‐effective with a 50% cost reduction. Conclusion First‐generation EGFR‐TKI therapy remained the most cost‐effective treatment option for advanced EGFR‐mutant NSCLC patients. Our results could serve as both a reference for both clinical practice and the formulation of medical insurance reimbursement.
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spelling doaj.art-5d2d7616c5014bc3aa9e17c94868c4912022-12-21T21:55:54ZengWileyCancer Medicine2045-76342021-03-011061964197410.1002/cam4.3733Cost‐effectiveness analysis of first‐line treatments for advanced epidermal growth factor receptor‐mutant non‐small cell lung cancer patientsWen‐Qian Li0Ling‐Yu Li1Jin Chai2Jiu‐Wei Cui3Department of Cancer center the First Hospital of Jilin University Changchun ChinaDepartment of Cancer center the First Hospital of Jilin University Changchun ChinaDepartment of pharmacy the Second Hospital of Jilin University Changchun ChinaDepartment of Cancer center the First Hospital of Jilin University Changchun ChinaAbstract Objectives Recent studies showed prolonged survival for advanced epidermal growth factor receptor (EGFR)‐mutant non‐small cell lung cancer (NSCLC) patients treated with both monotherapies and combined therapies. However, high costs limit clinical applications. Thus, we conducted this cost‐effectiveness analysis to explore an optimal first‐line treatment for advanced EGFR‐mutant NSCLC patients. Materials and Methods Survival data were extracted from six clinical trials, including ARCHER1050 (dacomitinib vs. gefitinib); FLAURA (osimertinib vs. gefitinib/erlotinib); JO25567 and NEJ026 (bevacizumab +erlotinib vs. erlotinib); NEJ009 (gefitinib +chemotherapy vs. gefitinib); and NCT02148380 (gefitinib +chemotherapy vs. gefitinib vs. chemotherapy) trials. Cost‐related data were obtained from hospitals and published literature. The effect parameter (quality‐adjusted life year [QALY]) was the reflection of both survival and utility. Incremental cost‐effectiveness ratio (ICER), average cost‐effectiveness ratio (ACER), and net benefit were calculated, and the willingness‐to‐pay (WTP) threshold was set at $30828/QALY from the perspective of the Chinese healthcare system. Sensitivity analysis was performed to explore the stability of results. Results We compared treatment groups with control groups in each trial. ICERs were $1897750.74/QALY (ARCHER1050), $416560.02/QALY (FLAURA), ‐$477607.48/QALY (JO25567), ‐$464326.66/QALY (NEJ026), ‐$277121.22/QALY (NEJ009), ‐$399360.94/QALY (gefitinib as comparison, NCT02148380), and ‐$170733.05/QALY (chemotherapy as comparison, NCT02148380). Moreover, ACER and net benefit showed that the combination of EGFR‐TKI with chemotherapy and osimertinib was of more economic benefit following first‐generation EGFR‐TKIs. Sensitivity analyses showed that the impact of utilities and monotherapy could be cost‐effective with a 50% cost reduction. Conclusion First‐generation EGFR‐TKI therapy remained the most cost‐effective treatment option for advanced EGFR‐mutant NSCLC patients. Our results could serve as both a reference for both clinical practice and the formulation of medical insurance reimbursement.https://doi.org/10.1002/cam4.3733cost‐effectivenessepidermal growth factor receptorfirst‐line therapynon‐small cell lung cancer
spellingShingle Wen‐Qian Li
Ling‐Yu Li
Jin Chai
Jiu‐Wei Cui
Cost‐effectiveness analysis of first‐line treatments for advanced epidermal growth factor receptor‐mutant non‐small cell lung cancer patients
Cancer Medicine
cost‐effectiveness
epidermal growth factor receptor
first‐line therapy
non‐small cell lung cancer
title Cost‐effectiveness analysis of first‐line treatments for advanced epidermal growth factor receptor‐mutant non‐small cell lung cancer patients
title_full Cost‐effectiveness analysis of first‐line treatments for advanced epidermal growth factor receptor‐mutant non‐small cell lung cancer patients
title_fullStr Cost‐effectiveness analysis of first‐line treatments for advanced epidermal growth factor receptor‐mutant non‐small cell lung cancer patients
title_full_unstemmed Cost‐effectiveness analysis of first‐line treatments for advanced epidermal growth factor receptor‐mutant non‐small cell lung cancer patients
title_short Cost‐effectiveness analysis of first‐line treatments for advanced epidermal growth factor receptor‐mutant non‐small cell lung cancer patients
title_sort cost effectiveness analysis of first line treatments for advanced epidermal growth factor receptor mutant non small cell lung cancer patients
topic cost‐effectiveness
epidermal growth factor receptor
first‐line therapy
non‐small cell lung cancer
url https://doi.org/10.1002/cam4.3733
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