title: Cross-market cost-effectiveness analysis of erlotinib as first-line maintenance treatment for patients with stable non-small cell lung cancer.
abstract: BACKGROUND
  Platinum-doublet, first-line treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC) is limited to 4-6 cycles. An alternative strategy used to prolong the duration of first-line treatment and extend survival in metastatic NSCLC is first-line maintenance therapy. Erlotinib was approved for first-line maintenance in a stable disease population following results from a randomized, controlled Phase III trial comparing erlotinib with best supportive care. We aimed to estimate the incremental cost-effectiveness of erlotinib 150 mg/day versus best supportive care when used as first-line maintenance therapy for patients with locally advanced or metastatic NSCLC and stable disease.
  
  
  METHODS
  An economic decision model was developed using patient-level data for progression-free survival and overall survival from the SATURN (SequentiAl Tarceva in UnResectable NSCLC) study. An area under the curve model was developed; all patients entered the model in the progression-free survival health state and, after each month, moved to progression or death. A time horizon of 5 years was used. The model was conducted from the perspective of national health care payers in France, Germany, and Italy. Probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  Treatment with erlotinib in first-line maintenance resulted in a mean life expectancy of 1.39 years in all countries, compared with a mean 1.11 years with best supportive care, which represents 0.28 life-years (3.4 life-months) gained with erlotinib versus best supportive care. In the base-case analysis, the cost per life-year gained was €39,783, €46,931, and €27,885 in France, Germany, and Italy, respectively.
  
  
  CONCLUSIONS
  Erlotinib is a cost-effective treatment option when used as first-line maintenance therapy for locally advanced or metastatic NSCLC.
authors.affiliation: Department of Pneumology, Hôpital du Cluzeau, Limoges, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Vergnenègre
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Ray
authors.forename: Christos
authors.initials: C
authors.lastname: Chouaid
authors.forename: Francesco
authors.initials: F
authors.lastname: Grossi
authors.forename: Helge G
authors.initials: HG
authors.lastname: Bischoff
authors.forename: David F
authors.initials: DF
authors.lastname: Heigener
authors.forename: Stefan
authors.initials: S
authors.lastname: Walzer