Cost-effectiveness analysis of EGFR mutation testing in patients with non-small cell lung cancer (NSCLC) with gefitinib or carboplatin-paclitaxel.
OBJECTIVE
Assess the cost-effectiveness of an EGFR-mutation testing strategy for advanced NSCLC in first-line therapy with either gefitinib or carboplatin-paclitaxel in Mexican institutions.


METHODS
Cost-effectiveness analysis using a discrete event simulation (DES) model to simulate two therapeutic strategies in patients with advanced NSCLC. Strategy one included patients tested for EGFR-mutation and therapy given accordingly. Strategy two included chemotherapy for all patients without testing. All results are presented in 2014 US dollars. The analysis was made with data from the Mexican frequency of EGFR-mutation. A univariate sensitivity analysis was conducted on EGFR prevalence. Progression-free survival (PFS) transition probabilities were estimated on data from the IPASS and simulated with a Weibull distribution, run with parallel trials to calculate a probabilistic sensitivity analysis.


RESULTS
PFS of patients in the testing strategy was 6.76 months (95 % CI 6.10-7.44) vs 5.85 months (95 % CI 5.43-6.29) in the non-testing group. The one-way sensitivity analysis showed that PFS has a direct relationship with EGFR-mutation prevalence, while the ICER and testing cost have an inverse relationship with EGFR-mutation prevalence. The probabilistic sensitivity analysis showed that all iterations had incremental costs and incremental PFS for strategy 1 in comparison with strategy 2.


CONCLUSIONS
There is a direct relationship between the ICER and the cost of EGFR testing, with an inverse relationship with the prevalence of EGFR-mutation. When prevalence is >10 % ICER remains constant. This study could impact Mexican and Latin American health policies regarding mutation detection testing and treatment for advanced NSCLC.
Unit of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), San Fernando #22, Col. Sección XVI, Tlalpan, 14080, México City, Mexico. ogarrieta@gmail.com.
Oscar
O
Arrieta
IMS Health, Mexico City, Mexico.
Pablo
P
Anaya
Unit of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), San Fernando #22, Col. Sección XVI, Tlalpan, 14080, México City, Mexico.
Vicente
V
Morales-Oyarvide
Unit of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), San Fernando #22, Col. Sección XVI, Tlalpan, 14080, México City, Mexico.
Laura Alejandra
LA
Ramírez-Tirado
AstraZeneca, Mexico City, Mexico.
Ana C
AC
Polanco
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D016190:Carboplatin / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000235:genetics*; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D000077156:Gefitinib; D018773:Genes, erbB-1 / Q000235:genetics*; D006801:Humans; D007843:Latin America; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000235:genetics*; D008297:Male; D008800:Mexico; D017059:Models, Econometric; D009154:Mutation; D017239:Paclitaxel / Q000627:therapeutic use; D047428:Protein Kinase Inhibitors / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D011799:Quinazolines / Q000191:economics* / Q000627:therapeutic use
D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D016190:Carboplatin; D017239:Paclitaxel; D000077156:Gefitinib
Carcinoma; Cost–benefit analysis; Developing countries; Health policy; Mutation; Non-small-cell lung