title: Cost-utility and budget impact analyses of gefitinib in second-line treatment for advanced non-small cell lung cancer from Thai payer perspective.
abstract: OBJECTIVE
  To evaluate the cost utility and budget impact of second-line gefitinib for non-small cell lung cancer from a Thai payer perspective.
  
  
  METHODS
  A Markov model with three health states (pre-progression, post-progression and death) was constructed to estimate direct medical costs and outcomes comparing four treatment options, i.e., gefitinib, erlotinib, pemetrexed and docetaxel. The model followed patients for 2 years with discount rate of 3% annually. Clinical inputs and patients' characteristics were based on a randomized phase III trial (INTEREST). Costs were based on reference prices published by the Ministry of Public Health, Thailand, and other information related to treatment from expert opinion and presented in 2010. Deterministic and probabilistic sensitivity analyses were performed to determine the impact of model parameters on results.
  
  
  RESULTS
  In the base case model, gefitinib and erlotinib yielded equal quality-adjusted life years (QALY) but 0.0140 and 0.0110 more QALY compared with docetaxel and pemetrexed, respectively. Total costs were 188 848 Baht (US$6237) for gefitinib, 196 313 Baht (US$6483) for docetaxel, 249 177 Baht (US$8229) for erlotinib and 275 303 Baht (US$9092) for pemetrexed. Drug acquisition contributed the greatest component. A series of sensitivity analyses demonstrated the robustness to various parameter variations except for docetaxel cost and duration of treatment. The budget impact analyses demonstrate the greater the percentage of substitution of gefitinib for docetaxel (ranging from 10-60%) the greater the cost saving.
  
  
  CONCLUSIONS
  Gefitinib is a dominant cost saving strategy compared with docetaxel for the second-line treatment of advanced NSCLC from the Thai payer perspective.
authors.affiliation: Department of Internal Medicine, Maharaj Nakorn Chiang Mai Hospital, Bangkok, Thailand.
authors.forename: Sumitra
authors.initials: S
authors.lastname: Thongprasert
authors.forename: Sirana
authors.initials: S
authors.lastname: Tinmanee
authors.forename: Unchalee
authors.initials: U
authors.lastname: Permsuwan
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D002017:Budgets; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D000077143:Docetaxel; D000069347:Erlotinib Hydrochloride; D000077156:Gefitinib; D005971:Glutamates / Q000008:administration & dosage; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D018803:Models, Economic; D000068437:Pemetrexed; D019057:Quality-Adjusted Life Years; D011799:Quinazolines / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D013785:Thailand; D016896:Treatment Outcome
chemical_list: D005971:Glutamates; D011799:Quinazolines; D043823:Taxoids; D000068437:Pemetrexed; D000077143:Docetaxel; D006147:Guanine; D000069347:Erlotinib Hydrochloride; D000077156:Gefitinib