Gene-guided gefitinib switch maintenance therapy for patients with advanced EGFR mutation-positive non-small cell lung cancer: an economic analysis.
BACKGROUND
Maintenance therapy with gefitinib notably improves survival in patients with advanced non-small cell lung cancer (NSCLC) and EGFR mutation-positive tumors, but the economic impact of this practice is unclear.


METHODS
A decision-analytic model was developed to simulate 21-day patient transitions in a 10-year time horizon. The clinical data were primarily obtained from the results of a pivotal phase III trial that assessed gefitinib maintenance treatment in patients with advanced NSCLC. The cost data were derived from the perspective of the Chinese health care system. The primary outcome was the incremental cost-effectiveness ratio (ICER) at a willingness-to-pay (WTP) threshold of 3 times the per capita GDP of China. Sensitivity analyses were used to explore the impact of uncertainty regarding the results. The impact of the gefitinib patient assistance program (GPAP) was evaluated.


RESULTS
After EGFR genotyping, gefitinib maintenance treatment for advanced NSCLC with EGFR mutations increased the life expectancy by 0.74 years and 0.46 QALYs compared with routine follow-up at an additional cost of $26,149.90 USD ($7,178.20 with the GPAP). The ICER for gefitinib maintenance was $57,066.40 and $15,664.80 per QALY gained (at a 3% discount rate) without and with the GPAP, respectively. The utility of progression free survival, the hazard ratio of progression-free survival for gefitinib treatment and the cost of gefitinib per dose were the three factors that had the greatest influence on the results.


CONCLUSIONS
These results indicate that gene-guided maintenance therapy with gefitinib with the GPAP might be a cost-effective treatment option.
Department of Pharmacy, Shanghai Chest Hospital, affiliated with the School of Medicine, Shanghai Jiaotong University, West Huaihai Road 241, Shanghai, China.
Jun
J
Zhu
Te
T
Li
Xiaohui
X
Wang
Ming
M
Ye
Jian
J
Cai
Yuejuan
Y
Xu
Bin
B
Wu
D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000191:economics* / Q000201:enzymology / Q000235:genetics / Q000401:mortality; D002681:China; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D016527:Drug Costs; D066246:ErbB Receptors / Q000037:antagonists & inhibitors* / Q000235:genetics; D000077156:Gefitinib; D006801:Humans; D008017:Life Expectancy; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000201:enzymology / Q000235:genetics / Q000401:mortality; D008390:Markov Chains; D008483:Medical Assistance / Q000191:economics; D018803:Models, Economic; D009154:Mutation; D057285:Precision Medicine / Q000191:economics; D047428:Protein Kinase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D011799:Quinazolines / Q000191:economics* / Q000627:therapeutic use; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D035501:Uncertainty
D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; C512478:EGFR protein, human; D066246:ErbB Receptors; D000077156:Gefitinib