Vivian W Y Lee1, Bjoern Schwander2, Victor H F Lee3. 1. School of Pharmacy, The Chinese University of Hong Kong, Shatin, Hong Kong. 2. AHEAD-Agency for Health Economic Assessment and Dissemination GmbH, Lörrach, Germany. 3. Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
Abstract
OBJECTIVE: To compare the effectiveness and cost-effectiveness of erlotinib versus gefitinib as first-line treatment of epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancer patients. DESIGN. Indirect treatment comparison and a cost-effectiveness assessment. SETTING: Hong Kong. PATIENTS: Those having epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancer. INTERVENTIONS: Erlotinib versus gefitinib use was compared on the basis of four relevant Asian phase-III randomised controlled trials: one for erlotinib (OPTIMAL) and three for gefitinib (IPASS; NEJGSG; WJTOG). The cost-effectiveness assessment model simulates the transition between the health states: progression-free survival, progression, and death over a lifetime horizon. The World Health Organization criterion (incremental cost-effectiveness ratio <3 times of gross domestic product/capita: <US$102 582; approximately <HK$798 078) was used to rate cost-effectiveness. RESULTS: The best fit of study characteristics and prognostic patient characteristics were found between the OPTIMAL and IPASS trials. Comparing progression-free survival hazard ratios of erlotinib versus gefitinib using only these randomised controlled trials in an indirect treatment comparison resulted in a statistically significant progression-free survival difference in favour of erlotinib (indirect treatment comparison hazard ratio=0.33; 95% confidence interval, 0.19-0.58; P=0.0001). The cost-effectiveness assessment model showed that the cost per progression-free life year gained and per quality-adjusted life year gained was at acceptable values of US$39 431 (approximately HK$306 773) and US$62 419 (approximately HK$485 619) for erlotinib versus gefitinib, respectively. CONCLUSION: The indirect treatment comparison of OPTIMAL versus IPASS shows that erlotinib is significantly more efficacious than gefitinib. Furthermore, the cost-effectiveness assessment indicates that the incremental cost-effectiveness ratios are well within an acceptable range in relation to the survival benefits obtained. In conclusion, erlotinib is cost-effective compared to gefitinib for first-line epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancer patients.
OBJECTIVE: To compare the effectiveness and cost-effectiveness of erlotinib versus gefitinib as first-line treatment of epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancerpatients. DESIGN. Indirect treatment comparison and a cost-effectiveness assessment. SETTING: Hong Kong. PATIENTS: Those having epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancer. INTERVENTIONS:Erlotinib versus gefitinib use was compared on the basis of four relevant Asian phase-III randomised controlled trials: one for erlotinib (OPTIMAL) and three for gefitinib (IPASS; NEJGSG; WJTOG). The cost-effectiveness assessment model simulates the transition between the health states: progression-free survival, progression, and death over a lifetime horizon. The World Health Organization criterion (incremental cost-effectiveness ratio <3 times of gross domestic product/capita: <US$102 582; approximately <HK$798 078) was used to rate cost-effectiveness. RESULTS: The best fit of study characteristics and prognostic patient characteristics were found between the OPTIMAL and IPASS trials. Comparing progression-free survival hazard ratios of erlotinib versus gefitinib using only these randomised controlled trials in an indirect treatment comparison resulted in a statistically significant progression-free survival difference in favour of erlotinib (indirect treatment comparison hazard ratio=0.33; 95% confidence interval, 0.19-0.58; P=0.0001). The cost-effectiveness assessment model showed that the cost per progression-free life year gained and per quality-adjusted life year gained was at acceptable values of US$39 431 (approximately HK$306 773) and US$62 419 (approximately HK$485 619) for erlotinib versus gefitinib, respectively. CONCLUSION: The indirect treatment comparison of OPTIMAL versus IPASS shows that erlotinib is significantly more efficacious than gefitinib. Furthermore, the cost-effectiveness assessment indicates that the incremental cost-effectiveness ratios are well within an acceptable range in relation to the survival benefits obtained. In conclusion, erlotinib is cost-effective compared to gefitinib for first-line epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancerpatients.
Authors: Yong-Jin Kim; Mark Oremus; Helen H Chen; Thomas McFarlane; Danielle Fearon; Susan Horton Journal: Pharmacoeconomics Date: 2021-03-31 Impact factor: 4.981
Authors: Ruxu You; Jinyu Liu; David Bin-Chia Wu; XinYu Qian; Boxiang Lyu; Yu Zhang; Nan Luo Journal: Cancer Manag Res Date: 2019-12-05 Impact factor: 3.989