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Pasello G, Lorenzi M, Scattolin D, Del Conte A, Cecere F, Pavan A, Macerelli M, Polo V, Pilotto S, Santarpia M, Cumerlato E, Da Ros V, Targato G, Bortolami A, Bonanno L, Ferro A, Dal Maso A, Frega S, Guarneri V. Osimertinib in Patients With Treatment-Naive EGFR-Mutant Non-small Cell Lung Cancer: Overall Survival, Post-progression Management and Budget Impact Analysis in Real-World. Oncologist 2024; 29:596-608. [PMID: 38520745 PMCID: PMC11224988 DOI: 10.1093/oncolo/oyae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/05/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION The observational multicenter prospective FLOWER study (NCT04965701) confirmed effectiveness and safety of osimertinib in the real-world (RW) management of untreated EGFR-mutant advanced non-small cell lung cancer (aNSCLC) patients. METHODS Herein, we report updated survival data, post-progression management, cost/effectiveness and budget impact (BI) of osimertinib compared with a RW population receiving gefitinib or erlotinib. RESULTS Overall, 189 Caucasian patients receiving first-line osimertinib were included. After a follow-up of 20.7 months, 74(39.2%) patients discontinued osimertinib, median time-to-treatment discontinuation (mTTD) was 27.9 months, overall survival 36.8 months. At progression, tissue biopsy was performed in 29 (56.9%), liquid biopsy in 15 (29.4%) and both in 7 (13.7%) cases. The most frequent resistant mechanism was MET amplification (N = 14, 29.8%). At data cutoff, 13 (6.9%) patients were continuing osimertinib beyond progression; 52 (67.5%) received second-line treatment; no further treatments were administered in 25 (32.5%) cases. Thirty-three (63.4%) patients received chemotherapy, 12(23.1%) TKIs combination. Cost-effectiveness analysis showed a total cost per patient based on RW mTTD of 98,957.34€, 21,726.28€ and 19,637.83€ for osimertinib, erlotinib and gefitinib, respectively. The incremental cost-effectiveness ratio (ICER)/month for osimertinib was 359,806.0€/life-year-gained (LYG) and 197,789.77€/LYG compared to erlotinib and gefitinib. For osimertinib, the BI-gap between RW-TTD and theoretical-TTD was 16,501.0€ per patient. CONCLUSIONS This updated analysis confirms the effectiveness of osimertinib in RW. Although the ICER of osimertinib seems not cost-effective, additional costs for the management of disease progression to old generation TKIs were not considered in this study. The BI-gap suggests RW mTTD as a more reliable measure for expense estimation.
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Affiliation(s)
- Giulia Pasello
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Martina Lorenzi
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Daniela Scattolin
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Alessandro Del Conte
- Medical Oncology and Immunorelated Tumors, National Cancer Institute Centro di Riferimento Oncologico (CRO) – IRCCS, Aviano (PN), Italy
| | - Fabiana Cecere
- Oncology 1, Regina Elena National Cancer Institute – IRCCS, Roma, Italy
| | - Alberto Pavan
- Medical Oncology Department, Azienda Unità Locale Socio Sanitaria (AULSS 3) Serenissima, Mestre-Venezia, Italy
| | - Marianna Macerelli
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Valentina Polo
- Oncology Unit, AULSS 2 Marca Trevigiana, Ca’ Foncello Hospital, Treviso, Italy
| | - Sara Pilotto
- Section of Innovation Biomedicine – Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verone, Italy
| | | | - Enrico Cumerlato
- Medical Oncology, AULSS 6 Euganea, South Padua Hospital, Monselice (PD), Italy
| | - Valentina Da Ros
- Medical Oncology and Immunorelated Tumors, National Cancer Institute Centro di Riferimento Oncologico (CRO) – IRCCS, Aviano (PN), Italy
| | - Giada Targato
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Alberto Bortolami
- Veneto Oncology Network, Istituto Oncologico Veneto, I.R.C.C.S., Padua, Italy
| | - Laura Bonanno
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Alessandra Ferro
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Alessandro Dal Maso
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Stefano Frega
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
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Raad A, Rizzo M, Appiah K, Kearns I, Hernandez L. Critical Examination of Modeling Approaches Used in Economic Evaluations of First-Line Treatments for Locally Advanced or Metastatic Non-Small Cell Lung Cancer Harboring Epidermal Growth Factor Receptor Mutations: A Systematic Literature Review. PHARMACOECONOMICS 2024; 42:527-568. [PMID: 38489077 PMCID: PMC11039500 DOI: 10.1007/s40273-024-01362-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, with up to 32% of patients with NSCLC harboring an epidermal growth factor receptor (EGFR) mutation. NSCLC harboring an EGFR mutation has a dedicated treatment pathway, with EGFR tyrosine kinase inhibitors and platinum-based chemotherapy often being the therapy of choice. OBJECTIVE The aim of this study was to systemically review and summarize economic models of first-line treatments used for locally advanced or metastatic NSCLC harboring EGFR mutations, as well as to identify areas for improvement for future models. METHODS Literature searches were conducted via Ovid in PubMed, MEDLINE, MEDLINE In-Process, Embase, Evidence-Based Medicine Reviews: Health Technology Assessment, Evidence-Based Medicine Reviews: National Health Service Economic Evaluation Database, and EconLit. An initial search was conducted on 19 December 2022 and updated on 11 April 2023. Studies were selected according to predefined criteria using the Population, Intervention, Comparator, Outcome and Study design (PICOS) framework. RESULTS Sixty-seven articles were included in the review, representing 59 unique studies. The majority of included models were cost-utility analyses (n = 52), with the remaining studies being cost-effectiveness analyses (n = 4) and a cost-minimization analysis (n = 1). Two studies incorporated both a cost-utility and cost-minimization analysis. Although the model structure across studies was consistently reported, justification for this choice was often lacking. CONCLUSIONS Although the reporting of economic models in NSCLC harboring EGFR mutations is generally good, many of these studies lacked sufficient reporting of justification for structural choices, performing extensive sensitivity analyses and validation in economic evaluations. In resolving such gaps, the validity of future models can be increased to guide healthcare decision making in rare indications.
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Affiliation(s)
| | | | | | | | - Luis Hernandez
- Takeda Pharmaceuticals America, Inc., Lexington, MA, USA.
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He Z, Huang X, Chen D, Wang G, Zhu Y, Li H, Han S, Shi L, Guan X. Sponsorship bias in published pharmacoeconomic evaluations of national reimbursement negotiation drugs in China: a systematic review. BMJ Glob Health 2023; 8:e012780. [PMID: 38030227 PMCID: PMC10689407 DOI: 10.1136/bmjgh-2023-012780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND China's National Reimbursement Drug List (NRDL) has become the primary route for drug reimbursement in China. More recently, the authority has made pharmacoeconomic evaluation an integral part of the application for NRDL inclusion. The underlying financial conflict of interests (FCOI) of pharmacoeconomic evaluations, however, has the potential to influence evidence generated and thus subsequent decision-making yet remains poorly understood. METHODS We searched for studies published between January 2012 and January 2022 on the 174 drugs added to the 2017-2020 NRDLs after successful negotiation. We categorised the study's FCOI status into no funding, industry funding, non-profit funding and multiple fundings based on authors' disclosure and assessed the reporting quality of included studies using the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist. We compiled descriptive statistics of funding types and study outcomes using t-tests and χ2 tests and conducted multivariate regression analysis. RESULTS We identified 378 records and our final sample included 92 pharmacoeconomic evaluations, among which 69.6% were conducted with at least one funding source. More than half (57.6%) of the evaluations reached favourable conclusions towards the intervention drug and 12.6% reached a dominant result of the intervention drug over the comparison from model simulation. The reporting quality of included studies ranged from 19 to 25 (on a scale of 28), with an average of 22.3. The statistical tests indicated that industry-funded studies were significantly more likely to conclude that the intervention therapy was economical (p<0.01) and had a significantly higher proportion of resulting target drug economically dominated the comparison drug (p<0.05). CONCLUSION The study revealed that FCOI bias is common in published pharmacoeconomic evaluations conducted in Chinese settings and could significantly influence the study's economical results and conclusions through various mechanisms. Multifaceted efforts are needed to improve transparency, comparability and reporting standardisation.
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Affiliation(s)
- Zixuan He
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xianqin Huang
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Dingyi Chen
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Guoan Wang
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Yuezhen Zhu
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Huangqianyu Li
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Sheng Han
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Luwen Shi
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xiaodong Guan
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
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Alali M, Saifo M. Optimizing the Treatment for Advanced Non-Small-Cell Lung Cancer with Mutated Epidermal Growth Factor Receptor in Low-Income Countries: A Review. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2023; 6:140-149. [PMID: 37637235 PMCID: PMC10448734 DOI: 10.36401/jipo-22-29] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 08/29/2023]
Abstract
Introduction Osimertinib is the treatment of choice for epidermal growth factor receptor (EGFR)-mutated advanced non-small-cell lung cancer (NSCLC). Because of its high price, many low-income countries, such as Syria, cannot provide osimertinib, which makes it difficult to choose the appropriate treatment for these patients. This study aimed to review articles that assessed tyrosine kinase inhibitors (TKIs) for advanced NSCLC and developed an appropriate treatment plan for Syrian patients. Methods An electronic literature search was conducted of published phase II and III studies that assessed the efficacy of EGFR-TKIs for advanced NSCLC between January 2003 and May 2022. Results Seventeen articles were reviewed. The results were similar when erlotinib or icotinib was compared with gefitinib. Progression-free survival and overall survival for afatinib and dacomitinib were longer than for gefitinib, with small significant differences. Osimertinib was the only TKI that showed efficacy against the T790M mutation, which showed an improvement over the first- and second-generation TKIs. Osimertinib as a first-line therapy is not cost-effective compared with first- and second-generation TKIs. Conclusion Osimertinib is the preferred first-line treatment in patients with advanced EGFR-mutated NSCLC. First- and second-generation TKIs are still considered good options, especially in low-income countries that cannot cover the costs of osimertinib.
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Affiliation(s)
- Mousa Alali
- Department of Oncology, Albairouni University Hospital, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Maher Saifo
- Department of Oncology, Albairouni University Hospital, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Faculty of Pharmacy, Alsham Private University, Damascus, Syrian Arab Republic
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Liu L, Jiang Z, Li F, Wei Y, Ming J, Yang Y, Liu S, Shi L, Chen Y. Were economic evaluations well reported for the newly listed oncology drugs in China's national reimbursement drug list. BMC Health Serv Res 2022; 22:1475. [PMID: 36463141 PMCID: PMC9719239 DOI: 10.1186/s12913-022-08858-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE To assess the reporting quality of published economic evaluations of the negotiated oncology drugs listed for China's 2020 National Reimbursement Drug List (NRDL). METHODS A comprehensive search was conducted to identify economic evaluation studies of negotiated oncology drugs listed in China's 2020 NRDL using the PubMed/MEDLINE, Embase, Web of Science, CNKI, SinoMed, and WanFang Database up to March 31, 2021. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist scored the reporting quality between 0 and 100. A linear regression analysis was employed to examine the influence of various characteristics on the reporting quality scores. RESULTS Eighty papers were included in the study, with the majority published during the past decade. Furthermore, more than half of the articles (57.5%, or 46 out of 80) were written in English. The average CHEERS score was 74.63 ± 12.75 and ranged from 43.48 to 93.75. The most inadequately reported items included choice of model, characterization of heterogeneity, and discussion, as well as currency, price date and conversion. Higher scores were associated with articles published from 2019 to 2021 and English publications. CONCLUSION The economic evaluation studies of negotiated oncology drugs listed in 2020 NRDL had moderate reporting quality. The Chinese economic evaluation publications could improve the reporting quality if the CHEERS checklist is consistently implemented. Also, the Chinese journals maybe explore introducing a reporting standard for economic evaluations.
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Affiliation(s)
- Liu Liu
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
| | - Zhixin Jiang
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
| | - Fuming Li
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
| | - Yan Wei
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
| | - Jian Ming
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China ,Real World Solutions, IQVIA China, Shanghai, China
| | - Yi Yang
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
| | - Shimeng Liu
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
| | - Lizheng Shi
- grid.265219.b0000 0001 2217 8588School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA USA
| | - Yingyao Chen
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
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Byun JY, Park SK, Ng BP, Liu YS, Kim CR, Park C. A systematic review of economic evaluations of tyrosine kinase inhibitors for non-small cell lung cancer (NSCLC). Expert Opin Pharmacother 2022; 23:1247-1257. [PMID: 35759783 DOI: 10.1080/14656566.2022.2095203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Although tyrosine kinase inhibitors (TKIs) have improved the efficacy of treatment for non-small cell lung cancer (NSCLC), the accessibility of TKIs is limited due to high costs. Despite the critical role of the cost-effectiveness of TKIs on decision-making, no systematic reviews have compared the cost-effectiveness of comparable TKIs. Therefore, we systemically reviewed the economic evaluation studies on various TKIs for NSCLC. AREAS COVERED We searched PubMed and the Cochran Library to identify the published economic evaluation studies of TKIs in NSCLC patients that were published by January 2022. All of the included studies (n = 38) evaluated the cost-effectiveness of epidermal growth factor receptor (EGFR)-TKIs (n = 29) or anaplastic lymphocyte kinase (ALK)-TKIs (n = 9). The cost-effectiveness results were reported as the incremental cost-effectiveness ratio per quality-adjusted life-year, except for three studies. EXPERT OPINION We found that the economic evaluation studies of the first and second generation of EGFR-TKIs and ALK-TKIs varied by the country and study settings, such as comparator and input parameters. In 12 studies, osimertinib (EGFR-TKI) was not cost-effective compared to other first/second EGFR-TKIs, regardless of the study settings. More evidence can be provided about cost-effectiveness of the third-generation TKIs in future research.
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Affiliation(s)
- Joo-Young Byun
- Health Outcomes Division, the University of Texas at Austin, College of Pharmacy, Austin, TX, USA.,School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Sun-Kyeong Park
- College of Pharmacy, the Catholic University of Korea, Bucheon, South Korea
| | - Boon Peng Ng
- College of Nursing & Disability Aging and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - Yi-Shao Liu
- Health Outcomes Division, the University of Texas at Austin, College of Pharmacy, Austin, TX, USA
| | - Chae-Rin Kim
- College of Pharmacy, the Catholic University of Korea, Bucheon, South Korea
| | - Chanhyun Park
- Health Outcomes Division, the University of Texas at Austin, College of Pharmacy, Austin, TX, USA
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Zhou X, Du J, Xu G, Chen C, Zheng B, Chen J. Cost-effectiveness of osimertinib versus placebo in resected EGFR-mutated non-small cell lung cancer in China. Cancer Med 2022; 11:4449-4456. [PMID: 35689472 PMCID: PMC9741963 DOI: 10.1002/cam4.4798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE We aim to assess whether osimertinib postoperative adjuvant therapy, compared with placebo, is cost-effective in China. METHODS We set up the Markov model that contains three health states over a 20-year period. Data were collected from the ADAURA trial that included transition probabilities and safety data. Through the analysis of literature and local charges, we explore both the cost and utility values. Sensitivity analyses were employed using TreeAge Pro software to access model stability. FINDINGS Patients in the osimertinib group had 1.46 more Quality-adjusted Life Years (8.45 QALYs vs 6.99 QALYs) than the placebo group at an incremental cost of $14098.51($39962.99 vs $25864.48). Compared with the placebo group, the treatment strategy with osimertinib postoperative adjuvant therapy had an incremental cost-effectiveness ratio of $9661.97/QALY. The probability of the osimertinib-assisted therapy strategy being cost-effective will reach 100% if the threshold of willingness to pay is above $15,000/QALY. IMPLICATIONS From the perspective of the Chinese Healthcare System, the treatment strategy with osimertinib postoperative adjuvant therapy is more cost-effective than the placebo strategy.
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Affiliation(s)
- Xiwen Zhou
- College of FinanceFujian Jiangxia UniversityFuzhouChina
| | - Jianting Du
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouFujianChina,Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouFujianChina
| | - Guobing Xu
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouFujianChina,Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouFujianChina
| | - Chun Chen
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouFujianChina,Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouFujianChina
| | - Bin Zheng
- Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouFujianChina,Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouFujianChina
| | - Jiahe Chen
- Department of Pharmaceutical and Health Economics, School of PharmacyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Wang Y, Huang K, Sun S, Deng Y, Xie X. Cost-Effectiveness Analysis of Gefitinib Alone and Combined with Chemotherapy as First-Line Treatment for Patients with Advanced Non-Small-Cell Lung Cancer. Healthc Policy 2022; 15:351-359. [PMID: 35256866 PMCID: PMC8898067 DOI: 10.2147/rmhp.s352827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background The rational choice of drugs for treating patients with advanced non-small-cell lung cancer (NSCLC) is significantly impacted by changes in modern drug policy, health insurance negotiation, and budget impact analyses. Here, we provide a basis for rational drug use decisions in clinical practice and promote the widespread use of pharmacoeconomic methods in clinical decision-making based on current drug policies in China and real-world data. Methods A Markov model was developed to evaluate the health and economic outcomes in patients with advanced NSCLC treated with first-line chemotherapy with gefitinib and gefitinib plus chemotherapy. Clinical data, cost, and utility data were extracted from published literature or real-world data; sensitivity analysis was performed to assess the uncertainty in the results. The results were summarized as QALYs and the ICER. Results The average cost and QALYs associated with gefitinib and gefitinib plus chemotherapy strategies were $62,882.83 and 1.70 and $84,509.30 and 1.93, respectively. The ICER for gefitinib plus chemotherapy versus gefitinib alone was $95,135.50. The one-way sensitivity analysis showed that the utility value of progressive disease (PD) had the greatest impact on the treatment outcome. Probabilistic sensitivity analysis showed that if China’s willingness to pay threshold was $33,300/QALY, the probability of superiority of the gefitinib plus chemotherapy regimen was 0. Conclusion The study suggests that, from the perspective of the Chinese health system, gefitinib plus chemotherapy is not a cost-effective option for NSCLC patients with EGFR mutations. These findings may help clinicians make the best treatment decisions for patients with NSCLC.
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Affiliation(s)
- Yao Wang
- School of Pharmacy, Anhui Medical University, Hefei, 230032, People's Republic of China.,Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China
| | - Kaiyu Huang
- School of Pharmacy, Anhui Medical University, Hefei, 230032, People's Republic of China.,Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China
| | - Sijia Sun
- School of Pharmacy, Anhui Medical University, Hefei, 230032, People's Republic of China.,Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China
| | - Yahong Deng
- School of Pharmacy, Anhui Medical University, Hefei, 230032, People's Republic of China.,Department of Pharmacy, First Affiliated Hospital of Anhui Medical University, Hefei, 230000, Anhui, People's Republic of China
| | - Xuefeng Xie
- School of Pharmacy, Anhui Medical University, Hefei, 230032, People's Republic of China.,Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China
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9
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Shu Y, Zhang Q, He X, Chen L. Cost-Effectiveness Analysis of Gefitinib Plus Chemotherapy versus Gefitinib Alone for Advanced Non-Small-Cell Lung Cancer with EGFR Mutations in China. Cancer Manag Res 2021; 13:8297-8306. [PMID: 34764692 PMCID: PMC8572736 DOI: 10.2147/cmar.s334643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/23/2021] [Indexed: 12/21/2022] Open
Abstract
Objective The aim of this study was to evaluate the cost-effectiveness of gefitinib plus chemotherapy (GCP) versus gefitinib alone for advanced non-small-cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations in China. Methods A decision-analytic Markov model was conducted to simulate the disease process of advanced NSCLC patients with EGFR mutations. Three distinct health states: progression-free survival (PFS), progressive disease (PD) and death were included. Clinical data were derived from the NEJ009 study. The cost was evaluated from the perspective of the Chinese society. Quality-adjusted life-years (QALYs) and incremental cost–effectiveness ratios (ICER) were calculated over a 10-year lifetime horizon. One-way sensitivity analysis and probabilistic sensitivity analysis were also performed to explore the uncertainty of parameters in the study. Results The base case analysis demonstrated that gefitinib plus chemotherapy gained 2.44 QALYs at an average cost of $59,571.34, while the effectiveness and cost of gefitinib group were 1.82 QALYs and $52,492.75, respectively. The ICER for gefitinib plus chemotherapy was $11,499.98 per QALY gained. The ICER was lower than the accepted willingness-to-pay (WTP) threshold, which was three times gross domestic product (GDP) per capita of China ($31,498.70 per QALY). Variation of parameters did not reverse the cost-effectiveness of gefitinib plus chemotherapy through univariable and probabilistic sensitivity analyses. Conclusion Our results showed that gefitinib plus chemotherapy is a cost-effective treatment option compared with gefitinib for advanced NSCLC patients with EGFR mutations in China.
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Affiliation(s)
- Yamin Shu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, People's Republic of China.,Department of Pharmacy, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Qilin Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xucheng He
- Pengzhou Second People's Hospital, Pengzhou, People's Republic of China
| | - Li Chen
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, People's Republic of China
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Wittlinger F, Laufer SA. The pre-clinical discovery and development of osimertinib used to treat non-small cell lung cancer. Expert Opin Drug Discov 2021; 16:1091-1103. [PMID: 34053372 DOI: 10.1080/17460441.2021.1936496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Osimertinib is currently the only FDA- and EMA-approved third-generation small-molecule epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI). It was initially indicated for second-line treatment of patients with metastatic EGFR T790M mutation-positive non-small cell lung cancer (NSCLC) and got approved for first-line treatment of EGFR activation mutation-positive metastatic NSCLC in 2018. Most recently, the FDA granted approval for the adjuvant treatment of patients with early-stage mutated EGFR NSCLC after tumor resection.Areas covered: This drug discovery case history focuses on the key studies that led to the preclinical discovery and development of osimertinib. The authors focus on published preclinical studies by scientists from AstraZeneca and highlight key events in the clinical development.Expert opinion: Although eventually compromised by the cellular plasticity of the tumor and the inevitable acquisition of drug resistance through the use of osimertinib, its key role in the treatment of NSCLC with specific EGFR mutations will be maintained in the near future. As the genome of EGFR is highly labile and since the rapid development of new mutants remains an issue, there is still room for improvement for the next generation of inhibitors.
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Affiliation(s)
- Florian Wittlinger
- Tuebingen Center for Academic Drug Discovery & Development, Institute of Pharmaceutical Sciences, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Stefan A Laufer
- Tuebingen Center for Academic Drug Discovery & Development, Institute of Pharmaceutical Sciences, Eberhard Karls Universität Tübingen, Tübingen, Germany
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