Cost effectiveness analysis of afatinib versus pemetrexed-cisplatin for first-line treatment of locally advanced or metastatic EGFR mutation positive non-small-cell lung cancer from the Singapore healthcare payer’s perspective

Tan, Ping-Tee; Aziz, Mohamed Ismail Abdul; Pearce, Fiona; Lim, Darren Wan-Teck; Wu, David Bin-Chia; Ng, Kwong

doi:10.1186/s12885-018-4223-y

Cited by 23 publications

(24 citation statements)

References 31 publications

(49 reference statements)

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“…Most studies analyzed the cost-effectiveness of EGFR testing [25][26][27][28][29] or EGFR-TKI versus chemotherapy as first-line treatment [30][31][32][33][34]. Direct comparisons between different first-line EGFR-TKIs, however, have been performed less frequently.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors: Analysis of real-world data in a tertiary hospital in Taiwan

et al. 2020

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IntroductionComparison of the effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors (TKIs) would improve patients' clinical benefits and save costs. Using realworld data, this study attempted to directly compare the effectiveness and cost-effectiveness of first-line afatinib, erlotinib, and gefitinib. MethodsDuring May 2011-December 2017, all patients with non-small cell lung cancer (NSCLC) visiting a tertiary center were invited to fill out the EuroQol five-dimension (EQ-5D) questionnaires and World Health Organization Quality of Life, brief version (WHOQOL-BREF), and received follow-ups for survival and direct medical costs. A total of 379 patients with EGFR mutation-positive advanced NSCLC under first-line TKIs were enrolled for analysis. After propensity score matching for the patients receiving afatinib (n = 48), erlotinib (n = 48), and gefitinib (n = 96), we conducted the study from the payers' perspective with a lifelong time horizon. ResultsPatients receiving afatinib had the worst lifetime psychometric scores, whereas the differences in quality-adjusted life expectancy (QALE) were modest. Considering 3 treatments together, afatinib was dominated by erlotinib. Erlotinib had an incremental cost-effectiveness of US$17,960/life year and US$12,782/QALY compared with gefitinib. Acceptability curves showed that erlotinib had 58.6% and 78.9% probabilities of being cost-effective given a threshold of 1 Taiwanese per capita GDP per life year and QALY, respectively.

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Section: Discussionmentioning

confidence: 99%

Comparative effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors: Analysis of real-world data in a tertiary hospital in Taiwan

et al. 2020

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“…According to the previously accepted descriptors reported by Hong et al, 27 the publications were categorized as being of good reporting quality if they were scored 20-24, and were deemed to be of moderate and low reporting quality if they were scored 14-19.5 and <14, respectively. Only five studies were of good quality based on the CHEERS checklist score, while 18 were of moderate quality and two were of low quality. The quality rankings of these studies were not correlated in relation with the years of publication.…”

Section: Quality Of Reportingmentioning

confidence: 99%

“…Only two studies were based on decision trees without a Markov component 16,17 and four were adopted from the same partitioned survival model with three health states. [18][19][20][21] Another five studies [22][23][24][25][26] were found that reported no economic model.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Less than half (48%) of publications reviewed were thus classified as high quality, and three studies (14.3%) are of poor quality, 22,24,25 while the average score of the selected studies was 71.52. The source of utility values that all selected studies extracted were also evaluated, and 17 out of 25 papers used values obtained from previously published literature, five studies derived utility data from EQ-5D or another quality of life survey, [17][18][19]23,32 and three studies used survival data from a single medical institution 16 or clinical trials. 20,21 A pairwise comparison demonstrated that there was no statistically significant difference between the results of the CHEERS and QHES instruments, p=0.51, illustrated in Figure 3.…”

Section: Articles Identified Through Database Search N=506mentioning

confidence: 99%

“…According to the Markov model articles, for item 3 in QHES, which weighted the subgroup analysis the lowest scoring, and items 16 and 21 in CHEERS, requiring specific model assumptions and descriptions of heterogeneity, there are four publications with large score difference. 5,15,33,34 Although the same-partitioned survival model was undertaken by four articles, [18][19][20][21] no justification for the choice of the model was disclosed in two of them, 20,21 which resulted in the inconsistency of scores evaluated by the CHEERS and QHES instruments.…”

Section: Articles Identified Through Database Search N=506mentioning

confidence: 99%

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<p>A Systematic Review of Health Economic Evaluation on Targeted Therapies for First-Line Treatment of Metastatic Non-Small Cell Lung Cancer (NSCLC): Quality Evaluation</p>

Zhao¹,

Du²,

Zhu³

et al. 2020

CMAR

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Background: Evolving practices in non-small cell lung cancer (NSCLC) therapy inevitably affect health care budgets, especially through the introduction of targeted therapies. This results in a rise of health economic evaluations (HEEs) in this domain. This article reviews the quality of the economic evidence of targeted therapies used in metastatic NSCLC. Methods: A literature search was conducted using PubMed, Cochrane, Embase and CRD (University of York Centre for Reviews and Dissemination) databases to identify topical original articles published between 1/1/2000 and 3/31/2019. A quality of reporting assessment using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards statement) checklist was converted into a quantitative score and compared with the results of a QHES (Quality of Health Economic Studies) evaluation. Components of QHES were also used to analyze the validity of primary outcomes, consideration of heterogeneity and rationality of main assumptions of models in modeling studies. Results: In total, 25 HEEs were obtained and analyzed. From the CHEERS assessment, it was found that method description integrity (including setting, perspective, time horizon and discount rate), justification of data sources and a heterogeneity description were often absent or incomplete. Only five examined studies met the accepted standard of good quality. Modeled articles were examined with the QHES instrument, and a lack of illustrated structure, population variability, formula of the transitioning probability and justification for the choice of the model were the most frequently observed problems in the selected studies. After quantification, the CHEERS scores and QHES scores did not differ significantly. Conclusion: Current NSCLC models generally lack consideration for demographic heterogeneity and transparency of data description, and it would be difficult to transfer or generalize from the scientific literature to real-world evidence-based decision-making. Frameworks of future models should be informed and justified based on the validity of model results and the improvement of modeling accuracy.

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Cost‐effectiveness of ribociclib as initial treatment for premenopausal women with advanced breast cancer in Singapore

et al. 2020

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Background CDK4/6 inhibitors have shown promising results for treating advanced breast cancer (ABC) and are routinely used in Singapore. In view of their high costs, it is important to assess their relative value compared to existing standards of care in the local setting. Aims This study evaluates the cost‐effectiveness of adding ribociclib to goserelin and a nonsteroidal aromatase inhibitor or tamoxifen as initial therapy for premenopausal women with hormone receptor‐positive (HR+), human epidermal growth factor receptor 2‐negative (HER2−) ABC in Singapore. Methods A partitioned survival model with four health states (progression‐free on first‐line treatment, progression‐free on second‐line treatment, progressed disease, and death) was developed from a healthcare system perspective over a 10‐year time horizon. Key clinical inputs were derived from the MONALEESA‐7 trial, and survival curves were extrapolated beyond the trial period. Health state utilities were derived from the literature and direct medical costs were obtained from local public healthcare institutions. A discount rate of 3% was applied to both costs and outcomes. One‐way deterministic and probabilistic sensitivity analyses were conducted to explore uncertainties. Results The base‐case analysis resulted in an incremental cost‐effectiveness ratio (ICER) of SGD197, 667 per quality‐adjusted life‐year. Sensitivity analyses showed that the ICER was sensitive to the survival parametric distribution, ribociclib price, time horizon, and utility weights used. Even when these were varied, ICERs remained high and not cost‐effective in the local context. Conclusion At its current price, adding ribociclib to endocrine therapy is unlikely to be cost‐effective in Singapore for HR+, HER2− ABC. Results from this study are useful to inform future funding decisions for CDK4/6 inhibitors alongside other factors including clinical effectiveness, safety, and budget impact considerations.

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Cost effectiveness analysis of afatinib versus pemetrexed-cisplatin for first-line treatment of locally advanced or metastatic EGFR mutation positive non-small-cell lung cancer from the Singapore healthcare payer’s perspective

Cited by 23 publications

References 31 publications

Comparative effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors: Analysis of real-world data in a tertiary hospital in Taiwan

Comparative effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors: Analysis of real-world data in a tertiary hospital in Taiwan

<p>A Systematic Review of Health Economic Evaluation on Targeted Therapies for First-Line Treatment of Metastatic Non-Small Cell Lung Cancer (NSCLC): Quality Evaluation</p>

Cost‐effectiveness of ribociclib as initial treatment for premenopausal women with advanced breast cancer in Singapore

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