title: Economic outcomes of maintenance gefitinib for locally advanced/metastatic non-small-cell lung cancer with unknown EGFR mutations: a semi-Markov model analysis.
abstract: BACKGROUND
  Maintenance gefitinib significantly prolonged progression-free survival (PFS) compared with placebo in patients from eastern Asian with locally advanced/metastatic non-small-cell lung cancer (NSCLC) after four chemotherapeutic cycles (21 days per cycle) of first-line platinum-based combination chemotherapy without disease progression. The objective of the current study was to evaluate the cost-effectiveness of maintenance gefitinib therapy after four chemotherapeutic cycle's stand first-line platinum-based chemotherapy for patients with locally advanced or metastatic NSCLC with unknown EGFR mutations, from a Chinese health care system perspective.
  
  
  RESULTS
  A semi-Markov model was designed to evaluate cost-effectiveness of the maintenance gefitinib treatment. Two-parametric Weibull and Log-logistic distribution were fitted to PFS and overall survival curves independently. One-way and probabilistic sensitivity analyses were conducted to assess the stability of the model designed. The model base-case analysis suggested that maintenance gefitinib would increase benefits in a 1, 3, 6 or 10-year time horizon, with incremental $184,829, $19,214, $19,328, and $21,308 per quality-adjusted life-year (QALY) gained, respectively. The most sensitive influential variable in the cost-effectiveness analysis was utility of PFS plus rash, followed by utility of PFS plus diarrhoea, utility of progressed disease, price of gefitinib, cost of follow-up treatment in progressed survival state, and utility of PFS on oral therapy. The price of gefitinib is the most significant parameter that could reduce the incremental cost per QALY. Probabilistic sensitivity analysis indicated that the cost-effective probability of maintenance gefitinib was zero under the willingness-to-pay (WTP) threshold of $16,349 (3 × per-capita gross domestic product of China). The sensitivity analyses all suggested that the model was robust.
  
  
  CONCLUSIONS
  Maintenance gefitinib following first-line platinum-based chemotherapy for patients with locally advanced/metastatic NSCLC with unknown EGFR mutations is not cost-effective. Decreasing the price of gefitinib may be a preferential choice for meeting widely treatment demands in China.
authors.affiliation: PET-CT Center, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Zeng
authors.affiliation: Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China ; School of Pharmaceutical Sciences, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Jianhe
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Liubao
authors.initials: L
authors.lastname: Peng
authors.affiliation: PET-CT Center, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Yunhua
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China ; School of Pharmaceutical Sciences, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Chongqing
authors.initials: C
authors.lastname: Tan
authors.affiliation: Department of Surgery, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Gannong
authors.initials: G
authors.lastname: Chen
authors.affiliation: Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China ; School of Pharmaceutical Sciences, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Xiaomin
authors.initials: X
authors.lastname: Wan
authors.affiliation: Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Qiong
authors.initials: Q
authors.lastname: Lu
authors.affiliation: Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Lidan
authors.initials: L
authors.lastname: Yi
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D002681:China; D003362:Cost-Benefit Analysis / Q000191:economics*; D003695:Delivery of Health Care / Q000191:economics*; D016527:Drug Costs; D000077156:Gefitinib; D006801:Humans; D060046:Maintenance Chemotherapy / Q000191:economics*; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D011799:Quinazolines / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D011799:Quinazolines; D000077156:Gefitinib