title: Cost-effectiveness of gefitinib, icotinib, and pemetrexed-based chemotherapy as first-line treatments for advanced non-small cell lung cancer in China.
abstract: Tyrosine kinase inhibitors of the epidermal growth factor receptor (EGFR) are becoming the standard treatment option for patients with advanced non-small cell lung cancer (NSCLC) harboring an EGFR mutation, but the economic impact of this practice is unclear, especially in a health resource-limited setting. A decision-analytic model was developed to simulate 21-day patient transitions in a 10-year time horizon. The health and economic outcomes of four first-line strategies (pemetrexed plus cisplatin [PC] alone, PC followed by maintenance with pemetrexed, or initial treatment with gefitinib or icotinib) among patients harboring EGFR mutations were estimated and assessed via indirect comparisons. Costs in the Chinese setting were estimated. The primary outcome was the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed. The icotinib strategy resulted in greater health benefits than the other three strategies in NSCLC patients harboring EGFR mutations. Relative to PC alone, PC followed by pemetrexed maintenance, gefitinib and icotinib resulted in ICERs of $104,657, $28,485 and $19,809 per quality-adjusted life-year gained, respectively. The cost of pemetrexed, the EGFR mutation prevalence and the utility of progression-free survival were factors that had a considerable impact on the model outcomes. When the icotinib Patient Assistance Program was available, the economic outcome of icotinib was more favorable. These results indicate that gene-guided therapy with icotinib might be a more cost-effective treatment option than traditional chemotherapy.
authors.affiliation: Department of Medical Oncology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Shun
authors.initials: S
authors.lastname: Lu
authors.affiliation: Department of Radiotherapy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Ye
authors.affiliation: Betta Pharmaceuticals Co., Ltd., Hangzhou, China.
authors.forename: Lieming
authors.initials: L
authors.lastname: Ding
authors.affiliation: Betta Pharmaceuticals Co., Ltd., Hangzhou, China.
authors.forename: Fenlai
authors.initials: F
authors.lastname: Tan
authors.affiliation: Medical Decision and Economic Group, Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Fu
authors.affiliation: Medical Decision and Economic Group, Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Wu
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000201:enzymology / Q000235:genetics / Q000473:pathology; D002681:China; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D043844:Crown Ethers / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D018572:Disease-Free Survival; D016527:Drug Costs; D066246:ErbB Receptors / Q000037:antagonists & inhibitors / Q000235:genetics; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000201:enzymology / Q000235:genetics / Q000473:pathology; D018803:Models, Economic; D058990:Molecular Targeted Therapy / Q000191:economics; D009154:Mutation; D000068437:Pemetrexed / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D057285:Precision Medicine / Q000191:economics; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D011799:Quinazolines / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D043844:Crown Ethers; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000068437:Pemetrexed; C531470:icotinib; C512478:EGFR protein, human; D066246:ErbB Receptors; D000077156:Gefitinib
keywords: EGFR mutation; cost-effectiveness; gefitinib; icotinib; non-small cell lung cancer