Clinical Epidemiology and Ageing

Cost-Effectiveness Analysis of Afatinib versus Gefitinib for First-Line Treatment of Advanced EGFR-Mutated Advanced Non-Small Cell Lung Cancers.

Chouaid C, Luciani L, LeLay K, Do P, Bennouna J, Perol M, Moro-Sibilot D, Vergnenègre A, de Pouvourville G J Thorac Oncol. 2017;12(10):1496-1502.

<p><b>INTRODUCTION: </b>The irreversible ErbB family blocker afatinib and the reversible EGFR tyrosine kinase inhibitor gefitinib were compared in the multicenter, international, randomized, head-to-head phase 2b LUX-Lung 7 trial for first-line treatment of advanced EGFR mutation-positive NSCLCs. Afatinib and gefitinib costs and patients' outcomes in France were assessed.</p><p><b>METHODS: </b>A partitioned survival model was designed to assess the cost-effectiveness of afatinib versus gefitinib for EGFR mutation-positive NSCLCs. Outcomes and safety were taken primarily from the LUX-Lung 7 trial. Resource use and utilities were derived from that trial, an expert-panel questionnaire, and published literature, limiting expenditures to direct costs. Incremental cost-effectiveness ratios (ICERs) were calculated over a 10-year time horizon for the entire population, and EGFR exon 19 deletion or exon 21 L858R mutation (L858R) subgroups. Deterministic and probabilistic sensitivity analyses were conducted.</p><p><b>RESULTS: </b>For all EGFR mutation-positive NSCLCs, the afatinib-versus-gefitinib ICER of was €45,211 per quality-adjusted life-year (QALY) (0.170 QALY gain for an incremental cost of €7697). ICERs for EGFR exon 19 deletion and L858R populations were €38,970 and €52,518, respectively. Afatinib had 100% probability to be cost-effective at a willingness-to-pay threshold of €70,000/QALY for patients with common EGFR mutations.</p><p><b>CONCLUSION: </b>First-line afatinib appears cost-effective compared with gefitinib for patients with EGFR mutation-positive NSCLCs.</p>

MeSH terms: Afatinib; Carcinoma, Non-Small-Cell Lung; Cost-Benefit Analysis; Gefitinib; Humans; Lung Neoplasms; Quinazolines; Radiation-Sensitizing Agents
DOI: 10.1016/j.jtho.2017.07.013