title: Cost-effectiveness of epidermal growth factor receptor mutation testing and first-line treatment with gefitinib for patients with advanced adenocarcinoma of the lung.
abstract: BACKGROUND
  Epidermal growth factor receptor (EGFR) testing and first-line therapy with gefitinib for patients with activating mutations is quickly becoming the standard option for the treatment of advanced lung adenocarcinoma. Yet, to date, little is known about the cost-effectiveness of this approach.
  
  
  METHODS
  A decision-analytic model was developed to determine the cost-effectiveness of EGFR testing and first-line treatment with gefitinib for those patients who harbor activating mutations versus standard care, which includes first-line treatment with chemotherapy followed by gefitinib as second-line treatment. The model uses clinical and outcomes data from randomized clinical trials and societal costs from Singapore cancer centers. Health effects were expressed as quality-adjusted life-years. All costs and cost-effectiveness ratios were expressed in 2010 Singapore dollars. Sensitivity and different scenarios analyses were conducted.
  
  
  RESULTS
  EGFR testing and first-line treatment with gefitinib is a dominant strategy (with lower costs and greater effectiveness) compared with standard care. Because the primary savings result from not providing gefitinib to those who are not likely to benefit, this finding holds regardless of the prevalence of activating mutations. In a secondary analysis, first-line treatment with gefitinib was also dominant when compared with first-line chemotherapy in patients with activating EGFR mutations.
  
  
  CONCLUSIONS
  This strategy can be considered a new standard of care and should be of great interest for health care payers and decision makers in an era in which our greatest challenge is to balance hard-won and incremental, yet small, improvements in patient outcomes with exponentially rising costs.
authors.affiliation: Johns Hopkins Singapore International Medical Centre, Singapore, Republic of Singapore. glopes@imc.jhmi.edu
authors.forename: Gilberto
authors.initials: G
authors.lastname: de Lima Lopes
authors.forename: Joel E
authors.initials: JE
authors.lastname: Segel
authors.forename: Daniel S W
authors.initials: DS
authors.lastname: Tan
authors.forename: Young K
authors.initials: YK
authors.lastname: Do
authors.forename: Tony
authors.initials: T
authors.lastname: Mok
authors.forename: Eric A
authors.initials: EA
authors.lastname: Finkelstein
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000235:genetics* / Q000401:mortality; D000077192:Adenocarcinoma of Lung; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D000068258:Bevacizumab; D000068818:Cetuximab; D003362:Cost-Benefit Analysis; D066246:ErbB Receptors / Q000235:genetics*; D000077156:Gefitinib; D005820:Genetic Testing / Q000191:economics*; D005971:Glutamates / Q000191:economics / Q000627:therapeutic use; D006147:Guanine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000235:genetics* / Q000401:mortality; D009154:Mutation / Q000235:genetics*; D000068437:Pemetrexed; D010597:Pharmacogenetics; D019057:Quality-Adjusted Life Years; D011799:Quinazolines / Q000191:economics* / Q000627:therapeutic use*; D012846:Singapore; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D005971:Glutamates; D011799:Quinazolines; D000068437:Pemetrexed; D000068258:Bevacizumab; D006147:Guanine; D066246:ErbB Receptors; D000068818:Cetuximab; D000077156:Gefitinib