Cost-utility analysis of first-generation EGFR-TKIs as the first-line treatment for advanced non-small cell lung cancer_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Qin ¹ , TIAN Panwen ² ,  LI Weimin ²

1. Department of Postgraduate Students, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

LI Weimin, Email: weimi003@scu.edu.cn

Keywords：

Non-small cell lung cancer; EGFR-TKI therapy; Markov model; Cost-utility

DOI：

10.7507/1672-2531.202212012

Video：

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Objective To compare the long-term cost-utility of three first-generation EGFR-TKIs targeted drugs, gefitinib, icotinib, and erlotinib as first-line treatments for advanced non-small cell lung cancer (NSCLC). Methods Real-world data were collected from 1 511 patients with advanced NSCLC treated with first-generation EGFR-TKIs as first-line treatment at West China Hospital of Sichuan University from 2009 to 2019. A three-state Markov model was established to evaluate the clinical efficacy, safety and cost-utility of three first-generation EGFR-TKIs targeted drugs. The transition probability of each state was obtained by survival analysis, the direct and indirect costs were calculated by the bottom-up method, the health utility value was obtained through literature research, the incremental cost effectiveness ratio (ICER) and quality-adjusted life years (QALYs) were calculated, and sensitivity analyses and Monte Carlo simulations were performed. Results There was no significant difference in clinical efficacy among the three first-generation EGFR-TKIs in the treatment of NSCLC. The incidence of skin rash and liver injury caused by gefitinib was significantly higher than that caused by icotinib and erlotinib (P<0.05). The average economic burden of patients treated with icotinib was the lowest (CNY 192 535.3) (P<0.01). The cost-utility ratio of icotinib (CNY 132 985.9/QALYs) was much lower than that of gefitinib (CNY 205 005.3/QALYs) and erlotinib (CNY 172 893.1/QALYs). Conclusion Compared with the three first-generation EGFR-TKIs drugs, icotinib is the most cost-effective.

Citation： ZHANG Qin, TIAN Panwen, LI Weimin. Cost-utility analysis of first-generation EGFR-TKIs as the first-line treatment for advanced non-small cell lung cancer. Chinese Journal of Evidence-Based Medicine, 2023, 23(3): 265-271. doi: 10.7507/1672-2531.202212012 Copy

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14.	国家医疗保障局. 关于将17种抗癌药纳入国家基本医疗保险、工伤保险和生育保险药品目录乙类范围的通知. 中老年保健, 2018, (12): 6.
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28.	张谦, 周文. 非小细胞肺癌患者的新选择-盐酸埃克替尼. 药学研究, 2013, 32(2): 121-124.
29.	Shi YK, Wang L, Han BH, et al. First-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance therapy for patients with advanced EGFR mutation-positive lung adenocarcinoma (CONVINCE): a phase 3, open-label, randomized study. Ann Oncol, 2017, 28(10): 2443-2450.
30.	戴冰, 占美, 刘怿晗, 等. 吉非替尼治疗晚期非小细胞肺癌药物经济学研究的循证评价. 中国药业, 2020, 29(15): 97-104.
31.	牟菲, 关月, 郭桂萍, 等. 埃克替尼治疗晚期非小细胞肺癌的快速卫生技术评估. 中国新药杂志, 2022, 31(9): 913-919.
32.	纪汶君, 门鹏, 王玉刚. 埃克替尼治疗非小细胞肺癌的快速卫生技术评估. 中国药师, 2022, 25(1): 102-112.

1. Islami F, Torre LA, Jemal A. Global trends of lung cancer mortality and smoking prevalence. Transl Lung Cancer Res, 2015, 4(4): 327-338.
2. Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol, 2015, 10(9): 1243-1260.
3. Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet, 2018, 391(10125): 1023-1075.
4. Hirsch FR, Bunn PA. EGFR testing in lung cancer is ready for prime time. Lancet Oncol, 2009, 10(5): 432-433.
5. Sárosi V, Balikó Z, Smuk G, et al. The frequency of EGFR mutation in lung adenocarcinoma and the efficacy of tyrosine kinase inhibitor therapy in a hungarian cohort of patients. Pathol Oncol Res, 2016, 22(4): 755-761.
6. Yang X, Yang K, Kuang K. The efficacy and safety of EGFR inhibitor monotherapy in non-small cell lung cancer: a systematic review. Curr Oncol Rep, 2014, 16(6): 390.
7. Zhou C, Wu YL, Chen G, et al. Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer (OPTIMAL, CTONG-0802): a multicentre, open-label, randomised, phase 3 study. Lancet Oncol, 2011, 12(8): 735-742.
8. Sequist LV, Yang JC, Yamamoto N, et al. Phase Ⅲ study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol, 2013, 31(27): 3327-3334.
9. Migliorino MR, Santo A, Romano G, et al. Economic burden of patients affected by non-small cell lung cancer (NSCLC): the LIFE study. J Cancer Res Clin Oncol, 2017, 143(5): 783-791.
10. Chouaïd C, Molinier L, Combescure C, et al. Economics of the clinical management of lung cancer in France: an analysis using a Markov model. Br J Cancer, 2004, 90(2): 397-402.
11. Vergnenegre A, Corre R, Berard H, et al. Cost-effectiveness of second-line chemotherapy for non-small cell lung cancer: an economic, randomized, prospective, multicenter phase III trial comparing docetaxel and pemetrexed: the GFPC 05-06 study. J Thorac Oncol, 2011, 6(1): 161-168.
12. McGuire A, Martin M, Lenz C, et al. Treatment cost of non-small cell lung cancer in three European countries: comparisons across France, Germany, and England using administrative databases. J Med Econ, 2015, 18(7): 525-532.
13. GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 2016, 388(10053): 1459-1544.
14. 国家医疗保障局. 关于将17种抗癌药纳入国家基本医疗保险、工伤保险和生育保险药品目录乙类范围的通知. 中老年保健, 2018, (12): 6.
15. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1. 1). Eur J Cancer, 2009, 45(2): 228-247.
16. National Cancer Institute. Common terminology criteria for adverse events v. 3.0 and v. 4.0 (CTCAE).
17. Castelli C, Combescure C, Foucher Y, et al. Cost-effectiveness analysis in colorectal cancer using a semi-Markov model. Stat Med, 2007, 26(30): 5557-5571.
18. 龙泳, 刘学东, 段利平, 等. 失能调整寿命年与人力资本法结合估计间接经济负担的研究. 中华流行病学杂志, 2007, 28(7): 708-711.
19. Nafees B, Lloyd AJ, Dewilde S, et al. Health state utilities in non-small cell lung cancer: an international study. Asia Pac J Clin Oncol, 2017, 13(5): e195-e203.
20. Nafees B, Stafford M, Gavriel S, et al. Health state utilities for non small cell lung cancer. Health Qual Life Outcomes, 2008, 6: 84.
21. Grutters JP, Joore MA, Wiegman EM, et al. Health-related quality of life in patients surviving non-small cell lung cancer. Thorax, 2010, 65(10): 903-907.
22. Chouaid C, Agulnik J, Goker E, et al. Health-related quality of life and utility in patients with advanced non-small-cell lung cancer: a prospective cross-sectional patient survey in a real-world setting. J Thorac Oncol, 2013, 8(8): 997-1003.
23. Labbé C, Leung Y, Silva Lemes JG, et al. Real-world EQ5D health utility scores for patients with metastatic lung cancer by molecular alteration and response to therapy. Clin Lung Cancer, 2017, 18(4): 388-395.
24. Brown J, Cook K, Adamski K, et al. Utility values associated with advanced or metastatic non-small cell lung cancer: data needs for economic modeling. Expert Rev Pharmacoecon Outcomes Res, 2017, 17(2): 153-164.
25. Alkhatib NS, Ramos K, Erstad B, et al. Pricing methods in outcome-based contracting: δ2: willingness-to-pay-based pricing. J Med Econ, 2020, 23(11): 1223-1229.
26. Nan X, Xie C, Yu X, et al. EGFR TKI as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer. Oncotarget, 2017, 8(43): 75712-75726.
27. Shi Y, Zhang L, Liu X, et al. Icotinib versus gefitinib in previously treated advanced non-small-cell lung cancer (ICOGEN): a randomised, double-blind phase 3 non-inferiority trial. Lancet Oncol, 2013, 14(10): 953-961.
28. 张谦, 周文. 非小细胞肺癌患者的新选择-盐酸埃克替尼. 药学研究, 2013, 32(2): 121-124.
29. Shi YK, Wang L, Han BH, et al. First-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance therapy for patients with advanced EGFR mutation-positive lung adenocarcinoma (CONVINCE): a phase 3, open-label, randomized study. Ann Oncol, 2017, 28(10): 2443-2450.
30. 戴冰, 占美, 刘怿晗, 等. 吉非替尼治疗晚期非小细胞肺癌药物经济学研究的循证评价. 中国药业, 2020, 29(15): 97-104.
31. 牟菲, 关月, 郭桂萍, 等. 埃克替尼治疗晚期非小细胞肺癌的快速卫生技术评估. 中国新药杂志, 2022, 31(9): 913-919.
32. 纪汶君, 门鹏, 王玉刚. 埃克替尼治疗非小细胞肺癌的快速卫生技术评估. 中国药师, 2022, 25(1): 102-112.

Chinese Journal of Evidence-Based Medicine

Cost-utility analysis of first-generation EGFR-TKIs as the first-line treatment for advanced non-small cell lung cancer

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