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

Abstract

BackgroundLung cancer is imposing significant pressure on the national health insurance system worldwide, especially under the COVID-19 pandemic. However, the cost-effectiveness of all available first-line treatments for patients with advanced epidermal growth factor receptor (EGFR) mutated non-small cell lung cancer (NSCLC) is still uncertain. The aim of this study was to evaluate the cost-effectiveness of 12 first-line treatments for patients with advanced EGFR mutated NSCLC from the perspective of the United Kingdom (UK) National Health Service and Chinese health care system.MethodsWe used a Markov model to estimate the cost-effectiveness of 12 treatments, including 6 EGFR tyrosine kinase inhibitors, 4 combination treatments and 2 chemotherapies. The key clinical efficacy and safety data were from a network meta-analysis. The cost and health preference were mainly collected from the literature. The most cost-effective treatment was inferred through a sequential analysis. Uncertainty was tested with one-way sensitivity analyses, scenario analyses, and probabilistic sensitivity analyses. Quality-adjusted life years (QALYs), direct medical costs, and incremental cost-effectiveness ratio (ICER) were estimated, at willingness-to-pay thresholds of £20000 to £50000 and £8000 to £24000 per QALY in the UK and China respectively.ResultsFor clinical effectiveness, osimertinib and gefitinib plus pemetrexed based chemotherapy (PbCT) yielded the highest QALYs, while two chemotherapy treatments gained the lowest QALYs. For costs, gefitinib treatment was the cheapest option in both countries (£24529 in the UK and £12961 in China). For cost-effectiveness, 4 treatments including gefitinib, gefitinib plus pemetrexed, gefitinib plus PbCT, and osimertinib formed the cost-effectiveness frontier in both countries. Gefitinib alone (70.7% and 80.0% under the threshold of £20000 and £8000 per QALY in the UK and China, respectively) and gefitinib plus PbCT (62.3% and 71.2% under the threshold of £50000 and £24000 per QALY in the UK and China, respectively) were most likely to be cost-effective compared with other first-line treatments.ConclusionsGefitinib and gefitinib plus PbCT were likely to be cost-effective for patients with advanced EGFR mutated NSCLC in both countries.

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.…”

Pharmacokinetics, bioequivalence, and safety studies of gefitinib tablet formulations: a randomized, open-label, two-period, two-sequence crossover study in Chinese healthy volunteers

“…Vital signs will be measured at various time points (1,3,6,8,12, 24, 72, 120, 168 hours) before and after drug administration. Medical staff will closely monitor and report adverse events throughout the trial.…”

“…Gefitinib, a first-generation EGFR-TKI, was authorized by the U.S. Food and Drug Administration (FDA) in 2003 and launched in China for treatment of non-small cell lung cancer (NSCLC) in February 2005. As the latest reported literature shows, gefitinib alone or chemotherapy with gefitinib plus pemetrexed may be cost-effective for patients with advanced EGFR mutated NSCLC in China [3,4] . Evaluating the bioequivalence or substitutability of the tested formulation with the reference formulation will undoubtedly facilitate the treatment and recovery of cancer patients.…”