Cost-effectiveness and safety of the molecular targeted drugs afatinib, gefitinib and erlotinib as first-line treatments for patients with advanced EGFR mutation-positive non-small-cell lung cancer

Abstract

Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), including gefitinib, erlotinib and afatinib are standard first-line treatments for EGFR gene mutation-positive non-small cell lung cancer. The present study aimed to compare the cost-effectiveness of using erlotinib, afatinib or gefitinib. The safety of EGFR-TKIs was also investigated. Expected costs were calculated based on data from patients with advanced EGFR mutation-positive non-small-cell lung cancer who were treated with gefitinib, erlotinib or afatinib. Literature was collected to obtain the necessary clinical information for calculating the probability and the validity of each chemotherapy. Median survival time (MST) was used to evaluate the therapeutic effect of the regimens. The cost-effectiveness ratio was calculated using expected costs and MSTs for the three regimens. The cost-effectiveness ratio per month was JPY 386,859.4/MST for afatinib, JPY 264,788.7/MST for gefitinib and JPY 397,039.9/MST for erlotinib. Significant differences were observed between the three groups (p<0.001). The incremental cost-effectiveness ratio (ICER) of gefitinib compared with afatinib per month was JPY 122,070.7/MST. The ICER of gefitinib compared with erlotinib was JPY -69,605.9/MST. Adverse effects of Grade 3 and higher, including diarrhoea (28.6%) and paronychia (14.3%) were observed in the afatinib treatment group. Paronychia (23.1%) was observed in the erlotinib treatment group, while none were observed in the gefitinib treatment group. These findings demonstrate that gefitinib is more cost effective in comparison with the afatinib and erlotinib regimens, although the afatinib and erlotinib regimens were well-tolerated and produce sufficient effects.

Hydroxysafflor yellow A inhibited lipopolysaccharide‐induced non‐small cell lung cancer cell proliferation, migration, and invasion by suppressing the PI3K/AKT/mTOR and ERK/MAPK signaling pathways

“…Currently, the main treatment methods for lung cancer include surgical and non‐surgical treatment; non‐surgical treatment consists of radiotherapy, chemotherapy, and immunity and molecular targeted drugs. However, there are many defects in both individual and comprehensive treatment schemes . Therefore, new and targeted drug research is the current focus for the prevention and treatment of lung cancer.…”

“…However, there are many defects in both individual and comprehensive treatment schemes. [5][6][7] Therefore, new and targeted drug research is the current focus for the prevention and treatment of lung cancer.…”

Real‐world health utility scores and toxicities to tyrosine kinase inhibitors in epidermal growth factor receptor mutated advanced non‐small cell lung cancer

“…Mutations in the epidermal growth factor receptor gene ( EGFR ) are the most common and actionable molecular aberrations in non‐small cell lung cancer (NSCLC) . Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR‐TKIs) are effective in the treatment of advanced lung cancers harbouring EGFR mutations ( EGFR m), but remain expensive especially given continuous dosing for the duration that a patient benefits from these TKIs …”

Non-small Cell Lung Cancer as a Chronic Disease – A Prospective Study from the Czech TULUNG Registry

“…Obviously, longer survival of patients with NSCLC definitely increases the overall healthcare costs for this category of patients. In terms of cost-effectiveness, a faceto-face comparison of three TKI treatment regimens (gefitinib, erlotinib and afatinib), gefitinib was found to be the most cost-effective TKI molecule (30). In a study by Tink et al, TKIs (erlotinib and afatinib) were found to be more cost-effective compared to cisplatin-pemetrexed treatment (31).…”