title: Effectiveness and cost-effectiveness of erlotinib versus gefitinib in first-line treatment of epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancer patients in Hong Kong.
abstract: OBJECTIVE
  To compare the effectiveness and cost-effectiveness of erlotinib versus gefitinib as first-line treatment of epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancer patients. DESIGN. Indirect treatment comparison and a cost-effectiveness assessment.
  
  
  METHODS
  Hong Kong.
  
  
  METHODS
  Those having epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancer.
  
  
  METHODS
  Erlotinib versus gefitinib use was compared on the basis of four relevant Asian phase-III randomised controlled trials: one for erlotinib (OPTIMAL) and three for gefitinib (IPASS; NEJGSG; WJTOG). The cost-effectiveness assessment model simulates the transition between the health states: progression-free survival, progression, and death over a lifetime horizon. The World Health Organization criterion (incremental cost-effectiveness ratio <3 times of gross domestic product/capita: <US$102 582; approximately <HK$798 078) was used to rate cost-effectiveness.
  
  
  RESULTS
  The best fit of study characteristics and prognostic patient characteristics were found between the OPTIMAL and IPASS trials. Comparing progression-free survival hazard ratios of erlotinib versus gefitinib using only these randomised controlled trials in an indirect treatment comparison resulted in a statistically significant progression-free survival difference in favour of erlotinib (indirect treatment comparison hazard ratio=0.33; 95% confidence interval, 0.19-0.58; P=0.0001). The cost-effectiveness assessment model showed that the cost per progression-free life year gained and per quality-adjusted life year gained was at acceptable values of US$39 431 (approximately HK$306 773) and US$62 419 (approximately HK$485 619) for erlotinib versus gefitinib, respectively.
  
  
  CONCLUSIONS
  The indirect treatment comparison of OPTIMAL versus IPASS shows that erlotinib is significantly more efficacious than gefitinib. Furthermore, the cost-effectiveness assessment indicates that the incremental cost-effectiveness ratios are well within an acceptable range in relation to the survival benefits obtained. In conclusion, erlotinib is cost-effective compared to gefitinib for first-line epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancer patients.
authors.affiliation: School of Pharmacy, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Vivian W Y
authors.initials: VW
authors.lastname: Lee
authors.affiliation: AHEAD-Agency for Health Economic Assessment and Dissemination GmbH, Lörrach, Germany.
authors.forename: Bjoern
authors.initials: B
authors.lastname: Schwander
authors.affiliation: Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Victor H F
authors.initials: VH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D066246:ErbB Receptors / Q000235:genetics*; D000069347:Erlotinib Hydrochloride; D005260:Female; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009154:Mutation; D047428:Protein Kinase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D011799:Quinazolines / Q000191:economics / Q000627:therapeutic use*
chemical_list: D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors; D000077156:Gefitinib
keywords: Antineoplastic agents; Carcinoma, non-small-cell lung; Cost-benefit analysis; Lung neoplasms