title: Economic Analysis of First-Line Treatment with Erlotinib in an EGFR-Mutated Population with Advanced NSCLC.
abstract: The cost-effectiveness of first-line tyrosine kinase inhibitor therapy in epidermal growth factor receptor gene (EGFR)-mutated advanced-stage non-small cell lung cancer (NSCLC) is poorly documented. We therefore conducted a cost-effectiveness analysis of first-line treatment with erlotinib versus standard chemotherapy in European patients with advanced-stage EGFR-mutated NSCLC who were enrolled in the European Erlotinib versus Chemotherapy trial.
  
  
  
  The European Erlotinib versus Chemotherapy study was a multicenter, open-label, randomized phase III trial performed mainly in Spain, France, and Italy. We based our economic analysis on clinical data and data on resource consumption (drugs, drug administration, adverse events, and second-line treatments) collected during this trial. Utility values were derived from the literature. Incremental cost-effectiveness ratios were calculated for the first-line treatment phase and for the overall strategy from the perspective of the three participating countries. Sensitivity analyses were performed by selecting the main cost drivers.
  
  
  
  Compared with standard first-line chemotherapy, the first-line treatment with erlotinib was cost saving (€7807, €17,311, and €19,364 for Spain, Italy and France, respectively) and yielded a gain of 0.117 quality-adjusted life-years. A probabilistic sensitivity analysis indicated that, given a willingness to pay at least €90,000 for 1 quality-adjusted life-year, the probability that a strategy of first-line erlotinib would be cost-effective was 100% in France, 100% in Italy, and 99.8% in Spain.
  
  
  
  This economic analysis shows that first-line treatment with erlotinib, versus standard chemotherapy, is a dominant strategy for EGFR-mutated advanced-stage NSCLC in three European countries.
authors.affiliation: Thoracic Oncological Unit, Limoges University Hospital, France. Electronic address: alain.vergnenegre@unilim.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Vergnenegre
authors.affiliation: Hospital General de Alicante, Alicante, Spain.
authors.forename: Bartomeu
authors.initials: B
authors.lastname: Massuti
authors.affiliation: European Institute of Oncology, Milan, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: de Marinis
authors.affiliation: Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain.
authors.forename: Enric
authors.initials: E
authors.lastname: Carcereny
authors.affiliation: Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Enriqueta
authors.initials: E
authors.lastname: Felip
authors.affiliation: Center for Cancer Disease François Baclesse, Caen, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Do
authors.affiliation: Hospital Universitario 12 de Octubre, Madrid, Spain; M. D. Anderson, Madrid, Spain.
authors.forename: Jose Miguel
authors.initials: JM
authors.lastname: Sanchez
authors.affiliation: Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigaciones Biomedicas de Sevilla, Seville, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Paz-Arez
authors.affiliation: Pneumology Unit, Creteil Hospital, France.
authors.forename: Christos
authors.initials: C
authors.lastname: Chouaid
authors.affiliation: Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Rosell
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000191:economics* / Q000235:genetics / Q000473:pathology; D003362:Cost-Benefit Analysis; D066246:ErbB Receptors / Q000037:antagonists & inhibitors / Q000235:genetics*; D000069347:Erlotinib Hydrochloride / Q000191:economics* / Q000627:therapeutic use; D005060:Europe / Q000453:epidemiology; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000235:genetics / Q000473:pathology; D009154:Mutation; D009367:Neoplasm Staging; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years
chemical_list: D047428:Protein Kinase Inhibitors; D000069347:Erlotinib Hydrochloride; C512478:EGFR protein, human; D066246:ErbB Receptors
keywords: EGFR-mutated patients; Economical analysis; Non–small cell lung cancer; Tyrosine kinase inhibitors