Cost analysis of erlotinib versus chemotherapy for first-line treatment of non-small-cell lung cancer in frail elderly patients participating in a prospective phase 2 study (GFPC 0505).
BACKGROUND
A large proportion of elderly patients (>70 years) with newly diagnosed NSCLC are shown to be frail by a comprehensive geriatric assessment. This population is more vulnerable to adverse effects of chemotherapy and might thus benefit more from targeted therapy. The objective of this study was to assess the cost-effectiveness of erlotinib followed by chemotherapy after progression, compared with the reverse strategy, in frail elderly patients with advanced NSCLC participating in a prospective randomized phase II trial (GFPC 0505).


METHODS
Outcomes (progression-free survival and overall survival) and costs (limited to direct medical costs, from the third-party payer perspective) were collected prospectively until second progression. Costs after progression and health utilities (based on disease states and grade 3-4 toxicities) were derived from the literature.


RESULTS
Median overall survival, QALYs, and total costs for the erlotinib-first strategy were 3.9 months, 0.33, and €15,233, respectively, compared with 4.4 months, 0.35, and €15,363 for the chemotherapy-first strategy. There was no significant difference between the 2 strategies in term of cost-effectiveness (respectively €47,381 and €44,350 per QALY).


CONCLUSIONS
No difference in cost-effectiveness was found between an erlotinib-first strategy and a chemotherapy-first strategy in frail elderly patients with NSCLC.
AP-HP Hôpital, St-Antoine, AP-HP, UMPC, Paris, France. christos.chouaid@sat.aphp.fr
Christos
C
Chouaid
Hervé
H
Le Caer
Romain
R
Corre
Jacquy
J
Crequit
Chrystelle
C
Locher
Lionel
L
Falchero
Cecile
C
Dujon
Henri
H
Berard
Isabelle
I
Monnet
Alain
A
Vergnenegre
D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D000069347:Erlotinib Hydrochloride; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D011446:Prospective Studies; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D011799:Quinazolines / Q000627:therapeutic use*
D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors