Costs of adverse events associated with erlotinib or afatinib in first-line treatment of advanced EGFR-positive non-small cell lung cancer

Abstract

ObjectivesEpidermal growth factor receptor–tyrosine kinase inhibitors (EGFR-TKIs) are an established treatment for advanced non-small cell lung cancer (NSCLC) with EGFR mutation. According to published meta-analyses, no significant efficacy differences have been demonstrated between erlotinib and afatinib. However, the incidence of EGFR–TKI-related adverse events (AEs) was lower with erlotinib. This study compares the cost of management of the AEs associated with these two drugs from the perspective of the Spanish National Health System (NHS).MethodsThe frequency of AEs was established from a recently published meta-analysis. In Spain, the daily cost of both drugs can be considered similar; as a result, only the costs of management of the AEs were considered. Costs and resource utilization in the management of the AEs were estimated by a panel of Spanish oncologists and from studies previously carried out in Spain. A probabilistic analysis was performed based on a Monte Carlo simulation.ResultsThe model generated 1,000 simulations. The total cost per patient treated with erlotinib and afatinib was €657.44 and €1,272.15, respectively. With erlotinib, the cost per patient and per AE of grades ≤2 and ≥3 was €550.86 and €106.58, respectively, whereas the cost with afatinib was €980.63 and €291.52, respectively. The reduction in the number of AEs with erlotinib could avoid a mean cost for the NHS of €614.71 (95% CI: €342.57–881.29) per patient.ConclusionIn advanced EGFR mutation-positive NSCLC patients, first-line treatment with erlotinib could reduce health care costs for the NHS, due to a decrease in the AE rate compared with afatinib. In long-term treatments, the avoidance of complications and the lowering of costs associated with the management of AEs are relevant factors that contribute to the sustainability of the health system.

Healthcare resource utilization and costs associated with patients prescribed afatinib or erlotinib as first-line therapy for EGFR mutation-positive NSCLC in the United States

“…Although previous research has suggested a lower incidence of adverse events with erlotinib compared to afatinib 21 , our analysis of real-world data showed no differences in HCRU that might have been expected given potential differences in tolerability profiles. Fewer afatinib patients experienced at least one inpatient or outpatient visit compared to erlotinib patients, whereas the proportion of patients requiring at least one outpatient office or other outpatient visit was similar between afatinib and erlotinib.…”

Clinical Utility of Rapid EGFR Genotyping in Advanced Lung Cancer

“…Despite these limitations, there are notable advantages to implementation of an assay that increases first-line use of EGFR TKIs, including cost savings relative to up-front treatment with chemotherapy and the potential to induce faster and more robust responses in symptomatic patients. 4,34–38 Although EGFR -mutant NSCLC is classically regarded as an indolent disease, many patients present with widely metastatic disease (Data Supplement). 39,40 The superior efficacy of EGFR TKIs relative to chemotherapy against brain metastases and the potential to defer brain radiation for these patients underscore the importance of rapid identification of EGFR mutations.…”

Il Costo Degli Eventi Avversi Associati ad Afatinib, Erlotinib e Gefitinib Nel Trattamento del Tumore del Polmone non a Piccole Cellule con Mutazione EGFR

“…Solo a fronte di una riduzione del tasso di incidenza della diarrea di grado ≥3, afatinib risulterebbe costoneutrale rispetto a erlotinib (dal 9% al 2,9%) e a gefitinib (dal 9% al 6,6%). Il risultato del confronto di erlotinib con afatinib viene confermato anche da una recente esperienza spagnola (41). Nello specifico, lo studio spagnolo, condotto con una metodologia simile alla nostra, ha determinato un maggiore costo di afatinib rispetto a erlotinib nella gestione degli EA associati al trattamento di prima linea del NSCLC in stadio avanzato con mutazione EGFR (41 ALT = alanina aminotransferasi; SSN = Sistema Sanitario Nazionale.…”

“…Il risultato del confronto di erlotinib con afatinib viene confermato anche da una recente esperienza spagnola (41). Nello specifico, lo studio spagnolo, condotto con una metodologia simile alla nostra, ha determinato un maggiore costo di afatinib rispetto a erlotinib nella gestione degli EA associati al trattamento di prima linea del NSCLC in stadio avanzato con mutazione EGFR (41 ALT = alanina aminotransferasi; SSN = Sistema Sanitario Nazionale. a Sono state considerate due confezioni da 10 cpr da 25 mg al prezzo al pubblico per confezione di €5,87.…”