Cost-effectiveness analysis of first and second-generation EGFR tyrosine kinase inhibitors as first line of treatment for patients with NSCLC harboring EGFR mutations

Abstract

Background: Tyrosine-kinase inhibitors (TKIs) have become the cornerstone treatment of patients with non-small cell lung cancer that harbor oncogenic EGFR mutations. The counterpart of these drugs is the financial burden that they impose, which often creates a barrier for accessing treatment in developing countries. The aim if the present study was to compare the cost-effectiveness of three different first and second generation TKIs. Methods: We designed a retrospective cost-effectiveness analysis of three different TKIs (afatinib, erlotinib, and gefitinib) administered as first-line therapy for patients with NSCLC that harbor EGFR mutations. Results: We included 99 patients with the following TKI treatment; 40 treated with afatinib, 33 with gefitinib, and 26 with erlotinib. Median PFS was not significantly different between treatment groups; 15.4 months (95% CI 9.3-19.5) for afatinib; 9.0 months (95% CI 6.3-NA) for erlotinib; and 10.0 months (95% CI 7.46-14.6) for gefitinib. Overall survival was also similar between groups: 29.1 months (95% CI 25.4-NA) for afatinib; 27.1 months (95% CI 17.1-NA) for erlotinib; and 23.7 months (95% CI 18.6-NA) for gefitinib. There was a statistically significant difference between the mean TKIs costs; being afatinib the most expensive treatment. This difference was observed in the daily cost of treatment (p < 0.01), as well as the total cost of treatment (p = 0.00095). Cost-effectiveness analysis determined that afatinib was a better cost-effective option when compared with first-generation TKIs (erlotinib and gefitinib). Conclusion: In our population, erlotinib, afatinib, and gefitinib were statistically equally effective in terms of OS and PFS for the treatment of patients with advanced EGFR-mutated NSCLC population. Owing to its marginally increased PFS and OS, the cost-effectiveness analysis determined that afatinib was a slightly better cost-effective option when compared with first-generation TKIs (erlotinib and gefitinib).

Critical Examination of Modeling Approaches Used in Economic Evaluations of First-Line Treatments for Locally Advanced or Metastatic Non-Small Cell Lung Cancer Harboring Epidermal Growth Factor Receptor Mutations: A Systematic Literature Review

“…For the remainder, studies stated that the use was for policy/funding decisions ( n = 5) [ 34 , 35 , 48 , 56 , 62 ], to promote the sustainability of limited healthcare resources ( n = 5) [ 30 – 32 , 60 , 61 ], or to support treatment choices ( n = 7) [ 39 , 47 , 50 , 55 , 57 , 59 , 65 ]. Twenty-two studies did not explicitly state the intended use of the economic evaluations [ 33 , 36 – 38 , 40 – 46 , 49 , 51 – 54 , 58 , 63 , 64 , 66 – 68 ].…”

“…All 59 studies included an EGFR TKI as an intervention; this was considered appropriate given the focus of the identified studies in patients harboring an EGFR mutation. The most frequently evaluated interventions were osimertinib ( n = 18) [ 30 , 32 , 34 , 35 , 38 , 40 , 44 , 47 , 50 , 51 , 55 , 62 , 68 , 71 , 73 , 78 , 83 , 88 ], dacomitinib ( n = 14) [ 31 , 32 , 40 , 42 , 43 , 47 , 52 , 53 , 63 , 67 , 72 , 74 , 82 , 87 ], afatinib ( n = 17) [ 32 , 33 , 36 , 39 , 40 , 45 , 46 , 56 , 57 , 59 , 65 , 66 , 69 , 70 , 77 , 80 , 86 ], gefitinib ( n = 12) [ 33 , 37 , 40 , 41 , 49 , 50 , 54 , 65 , 69 , 75 , 81 , 84 ], and erlotinib ( n = 12) [ 32 , 40 , 50 , ...…”

“…Ramucirumab, an immunotherapy, was included in a combination treatment arm with erlotinib in one economic evaluation [ 48 ]; the rationale in the investigation of this treatment was to support policy decision toward its listing in China [ 48 ]. Twelve studies [ 32 , 33 , 40 , 46 , 47 , 49 , 50 , 57 , 62 , 64 , 65 , 69 ] had a primary aim to evaluate multiple first-line treatments.…”

Insights into fourth generation selective inhibitors of (C797S) EGFR mutation combating non-small cell lung cancer resistance: a critical review

“…In addition, a cost-effectiveness analysis determined that afatinib ( 5 ) was more cost-effective than its alternative of the first-generation TKIs (erlotinib ( 2 ) and gefitinib ( 1 )). 128…”

Cost-Effectiveness of 12 First-Line Treatments for Patients With Advanced EGFR Mutated NSCLC in the United Kingdom and China

“…Most published economic evaluations have just compared two treatments in the first-line setting for advanced EGFR mutated NSCLC ( 8 – 13 ). Only a few articles compared the cost-effectiveness of multiple treatments for these patients ( 14 – 19 ), but they have not incorporated all available EGFR-TKIs and recent alternative combination treatments, such as gefitinib plus pemetrexed based chemotherapy (PbCT), erlotinib plus bevacizumab et al. Thus, they failed to show the full picture of the cost-effectiveness of all available first-line treatments for advanced EGFR mutated NSCLC.…”