Background The therapeutic landscape for non-small-cell lung cancer (NSCLC) patients that have common epidermal growth factor receptor (EGFR) mutations has changed radically in the last decade. The availability of these treatment options has an economic impact, therefore a budget impact analysis was performed. Methods A budget impact analysis was conducted from a Dutch healthcare perspective over a 5-year time horizon in EGFR-mutant NSCLC patients receiving first-line afatinib (Gilotrif ®) versus first-line osimertinib (Tagrisso ®), followed by subsequent treatments. A decision analysis model was constructed in Excel. Scenario analyses and one-way sensitivity analysis were used to test the models' robustness. Results Sequential treatment with afatinib versus first-line treatment with osimertinib showed mean total time on treatment (ToT) of 29.1 months versus 24.7 months, quality-adjusted life months (QALMs) of 20.2 versus 17.4 with mean cost of €108,166 per patient versus €143,251 per patient, respectively. The 5-year total budget impact was €110.4 million for the afatinib sequence versus €158.6 million for the osimertinib sequence, leading to total incremental cost savings of €48.15 million. Conclusions First-line afatinib treatment in patients with EGFR-mutant NSCLC had a lower financial impact on the Dutch healthcare budget with a higher mean ToT and QALM compared to osimertinib sequential treatment.

Objectives Progressive fibrosing interstitial lung disease (PF-ILD) is characterised by increased pulmonary fibrosis, lung function decline, acute exacerbations, decreased quality of life and increased mortality. Nintedanib may slow down disease progression, but long-term outcomes are unknown. We aimed to assess the cost-effectiveness of nintedanib in comparison to placebo, both on top of usual care in patients with PF-ILD. Methods An individual PF-ILD patient simulation model was created, using data and extrapolations from the nintedanib and placebo arms of the INBUILD trial. Clinical outcomes (mortality, exacerbations, lung transplants), economic outcomes (direct and indirect costs) and the cost-effectiveness of nintedanib over a 10-year time horizon were forecasted using the Netherlands as a case example. Disease progression was driven by lung function decline, with forced vital capacity (FVC) health states ranging from < 40 to ≥ 110 FVC of % predicted. Sensitivity and scenario analyses were performed to assess the impact of parameter assumptions on the cost-effectiveness and to test model robustness. Results Over a 10-year follow-up, nintedanib gained an average of 1.31 discounted life years and an average of 0.87 discounted quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of €60,690 per QALY. Sensitivity analyses showed cost variations had a minor impact on the ICER. Results were mainly driven by mortality probabilities and diseaserelated utilities. Scenario analyses indicated most sensitivity to the time horizon and lung transplantation costs. Conclusion Long-term treatment with nintedanib could result in considerable health gains for patients with PF-ILD and can be considered cost-effective under the common willingness-to-pay threshold.

Resource use estimates were derived from the literature and analysis of national hospital episode statistics. Diagnosis-related group costs were used (V 2018), supplemented with cost data from Irish tertiary hospitals and the literature. A full incremental analysis was conducted, with incremental cost per quality adjusted life year (QALY) as the outcome. Probabilistic and deterministic sensitivity analyses were conducted. Results: Ipilimumab was excluded due to extended dominance, and nivolumab was dominant of pembrolizumab. The ICER for nivolumab versus dacarbazine was V85,044/QALY (incremental costs V63,163, incremental QALYs 0.81) and for NIVO-IPI versus nivolumab was V287,501/QALY (incremental costs V89,270, incremental QALYs 0.31). Outcomes were most sensitive to assumptions regarding survival, treatment costs, and discount rates. The probability of cost-effectiveness for nivolumab at the Irish cost-effectiveness threshold of V45,000/QALY was 9%. Conclusions: CIs are not cost-effective for the treatment of AM at the Irish cost-effectiveness threshold of V45,000/QALY.