title: A systematic review of the cost-effectiveness of targeted therapies for metastatic non-small cell lung cancer (NSCLC).
abstract: BACKGROUND
  Non-small cell lung cancer (NSCLC) imposes a substantial burden on patients, health care systems and society due to increasing incidence and poor survival rates. In recent years, advances in the treatment of metastatic NSCLC have resulted from the introduction of targeted therapies. However, the application of these new agents increases treatment costs considerably. The objective of this article is to review the economic evidence of targeted therapies in metastatic NSCLC.
  
  
  METHODS
  A systematic literature review was conducted to identify cost-effectiveness (CE) as well as cost-utility studies. Medline, Embase, SciSearch, Cochrane, and 9 other databases were searched from 2000 through April 2013 (including update) for full-text publications. The quality of the studies was assessed via the validated Quality of Health Economic Studies (QHES) instrument.
  
  
  RESULTS
  Nineteen studies (including update) involving the MoAb bevacizumab and the Tyrosine-kinase inhibitors erlotinib and gefitinib met all inclusion criteria. The majority of studies analyzed the CE of first-line maintenance and second-line treatment with erlotinib. Five studies dealt with bevacizumab in first-line regimes. Gefitinib and pharmacogenomic profiling were each covered by only two studies. Furthermore, the available evidence was of only fair quality.
  
  
  CONCLUSIONS
  First-line maintenance treatment with erlotinib compared to Best Supportive Care (BSC) can be considered cost-effective. In comparison to docetaxel, erlotinib is likely to be cost-effective in subsequent treatment regimens as well. The insights for bevacizumab are miscellaneous. There are findings that gefitinib is cost-effective in first- and second-line treatment, however, based on only two studies. The role of pharmacogenomic testing needs to be evaluated. Therefore, future research should improve the available evidence and consider pharmacogenomic profiling as specified by the European Medicines Agency. Upcoming agents like crizotinib and afatinib need to be analyzed as well.
authors.affiliation: Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Str, 1, D-30159 Hannover, Germany. al@ivbl.uni-hannover.de.
authors.forename: Ansgar
authors.initials: A
authors.lastname: Lange
authors.forename: Anne
authors.initials: A
authors.lastname: Prenzler
authors.forename: Martin
authors.initials: M
authors.lastname: Frank
authors.forename: Heiko
authors.initials: H
authors.lastname: Golpon
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.forename: J-Matthias
authors.initials: JM
authors.lastname: von der Schulenburg
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000191:economics; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage / Q000191:economics; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000556:secondary; D003362:Cost-Benefit Analysis; D000069347:Erlotinib Hydrochloride / Q000008:administration & dosage / Q000191:economics; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D058990:Molecular Targeted Therapy / Q000191:economics*; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000191:economics; D011799:Quinazolines / Q000008:administration & dosage / Q000191:economics
chemical_list: D000911:Antibodies, Monoclonal; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000068258:Bevacizumab; D000069347:Erlotinib Hydrochloride; D000077156:Gefitinib