Erlotinib or best supportive care for third-line treatment of advanced non-small-cell lung cancer: a real-world cost-effectiveness analysis.
Erlotinib has been approved as a third-line treatment for advanced non-small-cell lung cancer (NSCLC) in British Columbia (BC). A cost-effectiveness analysis was conducted to compare costs and effectiveness in patients who received third-line erlotinib to those in a historical patient cohort that would have been eligible had erlotinib been available.


METHODS
In a population of patients who have been treated with drugs for advanced NSCLC, overall survival (OS), progression-to-death survival (PTD) and probability of survival one year after end of second-line (1YS) were determined using a Kaplan-Meier survival analysis. Costs were collected retrospectively from the perspective of the BC health care system.


RESULTS
Incremental mean OS was 90 days (0.25 LYG), and incremental mean cost was $11,102 (CDN 2009), resulting in a mean ICER of $36,838/LYG. Univariate sensitivity analysis yielded ICERs ranging from $21,300 to $51,700/LYG.


CONCLUSIONS
Our analysis suggests that erlotinib may be an effective and cost-effective third-line treatment for advanced NSCLC compared to best supportive care.
Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC, Canada. icromwell@bccrc.ca
Ian
I
Cromwell
Kimberly
K
van der Hoek
Suzanne C
SC
Malfair Taylor
Barbara
B
Melosky
Stuart
S
Peacock
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality / Q000473:pathology; D003362:Cost-Benefit Analysis; D000069347:Erlotinib Hydrochloride; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D047428:Protein Kinase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D011799:Quinazolines / Q000191:economics* / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride