title: Cost-effectiveness of three strategies for second-line erlotinib initiation in nonsmall-cell lung cancer: the ERMETIC study part 3.
abstract: Several clinical and biological parameters are known to influence the efficacy of second-line erlotinib therapy for nonsmall cell lung cancer (NSCLC), but their medico-economic impact has not been evaluated. The objective of this study was to compare the incremental cost-effectiveness ratios of strategies for second-line erlotinib initiation in NSCLC: clinically guided initiation (nonsmoking females with adenocarcinoma received erlotinib; all other patients received docetaxel) and biologically guided selection (patients with epidermal growth factor receptor (EGFR) mutation received erlotinib; patients with wild-type EGFR or unknown status received docetaxel), compared with initiation with no patient selection (strategy reference). A Markov model was constructed. Outcomes (overall and progression-free survival), transition probabilities and direct medical costs (from the French third-party payer's perspective) were prospectively collected for individual patients treated with either erlotinib or docetaxel, from treatment initiation to disease progression. Published data were used to estimate utilities and post-progression costs. Sensitivity analyses were performed. The biologically and clinically guided strategies were both more efficient (incremental quality-adjusted life-yrs equal to 0.080 and 0.081, respectively) and less expensive (cost decrease equal to €5,020 and €5,815, respectively) than the no-selection strategy, and the biologically guided strategy was slightly less expensive than the clinically guided strategy. Sensitivity analyses confirmed the robustness of the results. The cost-effectiveness of second-line NSCLC treatment is improved when patients are selected on either clinical or biological grounds.
authors.affiliation: Etudes et Recherche en Économie de la Santé, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France. isabelle.borget@igr.fr
authors.forename: I
authors.initials: I
authors.lastname: Borget
authors.forename: J
authors.initials: J
authors.lastname: Cadranel
authors.forename: J-P
authors.initials: JP
authors.lastname: Pignon
authors.forename: E
authors.initials: E
authors.lastname: Quoix
authors.forename: B
authors.initials: B
authors.lastname: Coudert
authors.forename: V
authors.initials: V
authors.lastname: Westeel
authors.forename: E
authors.initials: E
authors.lastname: Dansin
authors.forename: J
authors.initials: J
authors.lastname: Madelaine
authors.forename: A
authors.initials: A
authors.lastname: Madroszyk
authors.forename: S
authors.initials: S
authors.lastname: Friard
authors.forename: C
authors.initials: C
authors.lastname: Daniel
authors.forename: F
authors.initials: F
authors.lastname: Morin
authors.forename: C
authors.initials: C
authors.lastname: Chouaid
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D066246:ErbB Receptors / Q000235:genetics; D000069347:Erlotinib Hydrochloride; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008390:Markov Chains; D008495:Medical Oncology / Q000191:economics / Q000379:methods; D008875:Middle Aged; D009154:Mutation; D047428:Protein Kinase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D011788:Quality of Life; D011799:Quinazolines / Q000191:economics / Q000627:therapeutic use*; D012680:Sensitivity and Specificity
chemical_list: D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors