Erlotinib or best supportive care for third-line treatment of advanced non-small-cell lung cancer: A real-world cost-effectiveness analysis

Cromwell, Ian; Hoek, Kimberly van der; Taylor, S. Martin; Melosky, Barbara; Peacock, Stuart

doi:10.1016/j.lungcan.2011.12.003

Cited by 23 publications

(33 citation statements)

References 8 publications

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“…These papers were published between 2002 and 2013; seven papers 63,65,66,[68][69][70][71] were published from 2010 onwards. All of the papers described full EEs using cost minimisation analysis (n = 1 64 ), cost-effectiveness analysis (n = 6 65,67,69,70,72 ) and/or cost-utility analysis (n = 6 [63][64][65]68,71,73 ) techniques. All but one study 70 used cost per QALY gained or cost per LY gained as the measure of cost-effectiveness.…”

Section: Cost-effectiveness Review: Resultsmentioning

confidence: 99%

“…All of the papers described full EEs using cost minimisation analysis (n = 1 64 ), cost-effectiveness analysis (n = 6 65,67,69,70,72 ) and/or cost-utility analysis (n = 6 [63][64][65]68,71,73 ) techniques. All but one study 70 used cost per QALY gained or cost per LY gained as the measure of cost-effectiveness. The results of six studies 64,65,67,68,71,73 were derived from use of an economic model: one study 63 conducted an economic analysis alongside a RCT and the remaining four studies 66,69,70,72 conducted retrospective reviews of costs and/or benefits.…”

Section: Cost-effectiveness Review: Resultsmentioning

confidence: 99%

“…The results of six studies 64,65,67,68,71,73 were derived from use of an economic model: one study 63 conducted an economic analysis alongside a RCT and the remaining four studies 66,69,70,72 conducted retrospective reviews of costs and/or benefits. Four studies 66,69,70,72 were carried out from a Canadian NHS perspective, two 67,71 from that of the UK NHS perspective, one 73 from the US perspective, three [63][64][65] from a European perspective and one 68 from a Thai payer perspective. None of the studies had a time horizon of longer than 3 years.…”

Section: Cost-effectiveness Review: Resultsmentioning

confidence: 99%

“…None of the studies had a time horizon of longer than 3 years. The authors of two studies 69,70 had not received any financial support from the pharmaceutical industry. ).…”

Section: Cost-effectiveness Review: Resultsmentioning

confidence: 99%

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Erlotinib and gefitinib for treating non-small cell lung cancer that has progressed following prior chemotherapy (review of NICE technology appraisals 162 and 175): a systematic review and economic evaluation

Greenhalgh

Bagust

Boland

et al. 2015

Health Technol Assess

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BackgroundLung cancer is the second most diagnosed cancer in the UK. Over 70% of lung cancers are non-small cell lung cancers (NSCLCs). Patients with stage III or IV NSCLC may be offered treatment to improve survival, disease control and quality of life. One-third of these patients receive further treatment following disease progression; these treatments are the focus of this systematic review.ObjectivesTo appraise the clinical effectiveness and cost-effectiveness of erlotinib [Tarceva®, Roche (UK) Ltd] and gefitinib (IRESSA®, AstraZeneca) compared with each other, docetaxel or best supportive care (BSC) for the treatment of NSCLC after disease progression following prior chemotherapy. The effectiveness of treatment with gefitinib was considered only for patients with epidermal growth factor mutation-positive (EGFR M+) disease.Data sourcesFour electronic databases (EMBASE, MEDLINE, The Cochrane Library, PubMed) were searched for randomised controlled trials (RCTs) and economic evaluations. Manufacturers’ evidence submissions to the National Institute for Health and Care Excellence were also considered.Review methodsOutcomes for three distinct patient groups based on EGFR mutation status [EGFR M+, epidermal growth factor mutation negative (EGFR M–) and epidermal growth factor mutation status unknown (EGFR unknown)] were considered. Heterogeneity of the data precluded statistical analysis. A de novo economic model was developed to compare treatments (incremental cost per quality-adjusted life-year gained).ResultsTwelve trials were included in the review. The use of gefitinib was compared with chemotherapy (n = 6) or BSC (n = 1), and the use of erlotinib was compared with chemotherapy (n = 3) or BSC (n = 1). One trial compared the use of gefitinib with the use of erlotinib. No trials included solely EGFR M+ patients; all data were derived from retrospective subgroup analyses from six RCTs [Kim ST, Uhm JE, Lee J, Sun JM, Sohn I, Kim SW,et al.Randomized phase II study of gefitinib versus erlotinib in patients with advanced non-small cell lung cancer who failed previous chemotherapy.Lung Cancer2012;75:82–8, V-15-32, Tarceva In Treatment of Advanced NSCLC (TITAN), BR.21, IRESSA Survival Evaluation in Lung cancer (ISEL) and IRESSA NSCLC Trial Evaluating REsponse and Survival versus Taxotere (INTEREST)]. These limited data precluded conclusions regarding the clinical effectiveness of any treatment for EGFR M+ patients. For EGFR M– patients, data were derived from the TArceva Italian Lung Optimization tRial (TAILOR) trial and Docetaxel and Erlotinib Lung Cancer Trial (DELTA). Retrospective data were also derived from subgroup analyses of BR.21, Kimet al., TITAN, INTEREST and ISEL. The only statistically significant reported results were for progression-free survival (PFS) for TAILOR and DELTA, and favoured docetaxel over erlotinib [TAILOR hazard ratio (HR) 1.39, 95% confidence interval (CI) 1.06 to 1.82; DELTA HR 1.44, 95% CI 1.08 to 1.92]. In EGFR unknown patients, nine trials (INTEREST, IRESSA as Second-line Therapy in Advanced NSCLC – KoreA, Li, Second-line Indication of Gefitinib in NSCLC, V-15-32, ISEL, DELTA, TITAN and BR.21) reported overall survival data and only one (BR.21) reported a statistically significant result favouring the use of erlotinib over BSC (HR 0.7, 95% CI 0.58 to 0.85). For PFS, BR.21 favoured the use of erlotinib when compared with BSC (HR 0.61, 95% CI 0.51 to 0.74) and the use of gefitinib was favoured when compared with BSC (HR 0.82, 95% CI 0.73 to 0.92) in ISEL. Limitations in the clinical data precluded assessment of cost-effectiveness of treatments for an EGFR M+ population by the Assessment Group (AG). The AG’s economic model suggested that for the EGFR M– population, the use of erlotinib was not cost-effective compared with the use of docetaxel and compared with BSC. For EGFR unknown patients, the use of erlotinib was not cost-effective when compared with BSC.Conclusions/future workThe lack of clinical data available for distinct patient populations limited the conclusions of the assessment. Future trials should distinguish between patients with EGFR M+ and EGFR M– disease.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Cost-effectiveness Review: Resultsmentioning

confidence: 99%

Section: Cost-effectiveness Review: Resultsmentioning

confidence: 99%

Section: Cost-effectiveness Review: Resultsmentioning

confidence: 99%

“…None of the studies had a time horizon of longer than 3 years. The authors of two studies 69,70 had not received any financial support from the pharmaceutical industry. ).…”

Section: Cost-effectiveness Review: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Erlotinib and gefitinib for treating non-small cell lung cancer that has progressed following prior chemotherapy (review of NICE technology appraisals 162 and 175): a systematic review and economic evaluation

Greenhalgh

Bagust

Boland

et al. 2015

Health Technol Assess

View full text Add to dashboard Cite

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“…Modeling and simulation (M&S) has been often used in cost-effective analysis for decision-making. 5,11,12) A Markov process model 13,14) has been used for modeling changes in disease conditions in patients, and a typical index such as the incremental cost-effective ratio (ICER) 15) has been used for this purpose. In a Markov model, transition probabilities are estimated from hazard rates of progression free survival (PFS) or overall survival (OS), and a time course profile of PFS or OS is not considered.…”

Section: )mentioning

confidence: 99%

Time-Series Modeling and Simulation for Comparative Cost-Effective Analysis in Cancer Chemotherapy: An Application to Platinum-Based Regimens for Advanced Non-small Cell Lung Cancer

Chisaki

Nakamura

Yano

2017

Biological & Pharmaceutical Bulletin

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The purpose of this study was to propose a time-series modeling and simulation (M&S) strategy for probabilistic cost-effective analysis in cancer chemotherapy using a Monte-Carlo method based on data available from the literature. The simulation included the cost for chemotherapy, for pharmaceutical care for adverse events (AEs) and other medical costs. As an application example, we describe the analysis for the comparison of four regimens, cisplatin plus irinotecan, carboplatin plus paclitaxel, cisplatin plus gemcitabine (GP), and cisplatin plus vinorelbine, for advanced non-small cell lung cancer. The factors, drug efficacy explained by overall survival or time to treatment failure, frequency and severity of AEs, utility value of AEs to determine QOL, the drugs' and other medical costs in Japan, were included in the model. The simulation was performed and quality adjusted life years (QALY) and incremental cost-effectiveness ratios (ICER) were calculated. An index, percentage of superiority (%SUP) which is the rate of the increased cost vs. QALYgained plots within the area of positive QALY-gained and also below some threshold values of the ICER, was calculated as functions of threshold values of the ICER. An M&S process was developed, and for the simulation example, the GP regimen was the most cost-effective, in case of threshold values of the ICER $70000/ year, the %SUP for the GP are more than 50%. We developed an M&S process for probabilistic cost-effective analysis, this method would be useful for decision-making in choosing a cancer chemotherapy regimen in terms of pharmacoeconomic.Key words pharmacoeconomic; cost-effectiveness; cancer chemotherapy; Monte Carlo simulation; modeling and simulation; non-small cell lung cancer In cancer chemotherapy, an important concern for patients is the efficacy of treatment, usually expressed by indices such as survival time and performance status. The high cost of cancer chemotherapy is a burden for both patients and the national economy; for example, the total cost of cancer therapy in the United States reported by National Cancer Institute (NCI) was $157 billion in 2010.1) It has also been reported that these costs may increase at a faster rate than overall medical expenditure 2) because new targeted anticancer therapies such as monoclonal antibodies and small-molecule inhibitors will be adopted as standard therapies, and therefore, more efficient but more expensive therapies will be used.A concept of pharmacoeconomics has been applied to a clinical pharmacy practice, 3,4) and a health care evaluation. 5)Several types of cost-effective analyses have been performed for choosing the optimal chemotherapy regimens for cancer patients. [6][7][8] The objectives of these cost-effective analyses were to compare two or more regimens from the viewpoint of increasing cost per increasing efficacy. From a pharmaceutical viewpoint, in order to choose the optimal regimen that provides the best cost-effective ratio, information regarding both treatments' efficacy and the frequency an...

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A Systematic Review of Economic Evaluations Assessing the Cost-Effectiveness of Licensed Drugs Used for Previously Treated Epidermal Growth Factor Receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK) Negative Advanced/Metastatic Non-Small Cell Lung Cancer

et al. 2019

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Background: Non-small cell lung cancer (NSCLC) is one of the most commonly diagnosed cancers. There are many published studies of cost-effectiveness analyses of licensed treatments, but no study has compared these studies or their approaches simultaneously. Objective: To investigate the methodology used in published economic analyses of licensed interventions for previously treated advanced/metastatic NSCLC in patients without anaplastic lymphoma kinase or epidermal growth factor receptor expression. Methods: A systematic review was performed, including a systematic search of key databases (e.g. MEDLINE, EMBASE, Web of Knowledge, Cost-effectiveness Registry) limited from 01 January 2001 to 26 July 2019. Two reviewers independently screened, data extracted and quality appraised studies identified. The reporting quality of the studies was assessed by using the Consolidated Health Economic Evaluation Reporting Standards and the Philips' checklists. Results: Thirty-one published records met the inclusion criteria which corresponded to 30 individual cost-effectiveness analyses. Analytical approaches included partitioned survival models (n=14), state-transition models (n=7) and retrospective analyses of new or published data (n=8). Model structure was generally consistent, with pre-progression, post-progression and death health states used most commonly. Other characteristics varied more widely, including the perspective of analysis, discounting, time horizon, usually to align with the country that the analysis was set in. Conclusions: There are a wide range of approaches in the modelling of treatments for advanced NSCLC, however the model structures are consistent. There is variation in the exploration of sensitivity analyses, with considerable uncertainty remaining in most evaluations. Improved reporting is necessary to ensure transparency in future analyses.

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Erlotinib or best supportive care for third-line treatment of advanced non-small-cell lung cancer: A real-world cost-effectiveness analysis

Cited by 23 publications

References 8 publications

Erlotinib and gefitinib for treating non-small cell lung cancer that has progressed following prior chemotherapy (review of NICE technology appraisals 162 and 175): a systematic review and economic evaluation

Erlotinib and gefitinib for treating non-small cell lung cancer that has progressed following prior chemotherapy (review of NICE technology appraisals 162 and 175): a systematic review and economic evaluation

Time-Series Modeling and Simulation for Comparative Cost-Effective Analysis in Cancer Chemotherapy: An Application to Platinum-Based Regimens for Advanced Non-small Cell Lung Cancer

A Systematic Review of Economic Evaluations Assessing the Cost-Effectiveness of Licensed Drugs Used for Previously Treated Epidermal Growth Factor Receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK) Negative Advanced/Metastatic Non-Small Cell Lung Cancer

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