Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
Department of Medical Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian Province, China.
Clin Ther. 2019 Feb;41(2):280-290. doi: 10.1016/j.clinthera.2018.12.007. Epub 2019 Jan 11.
This study aimed to evaluate the cost-effectiveness of osimertinib with gefitinib or erlotinib as first-line and sequential therapy for epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC) in China.
The Markov model was used, and the study included 3 health states over a 10-year period. Transition probabilities and safety data were collected from the FLAURA (AZD9291 versus gefitinib or erlotinib in patients with locally advanced or metastatic Non-small Cell Lung Cancer) trial. Cost and utility values were derived from local charges and literature. Sensitivity analyses were performed to observe model stability.
The strategy with gefitinib or erlotinib first-line therapy and second-line gene-guided osimertinib therapy (GE-T790M) resulted in a gain of 0.31 quality-adjusted life year (QALY) at a cost of $15,200.95 per patient compared with the gefitinib or erlotinib first-line therapy and second-line chemotherapy (GE-chemotherapy). The incremental QALY and incremental cost values for first-line osimertinib therapy compared with GE-chemotherapy was 0.96 and $69,420.76, respectively. Compared with the GE-T790M strategy (0.96 QALY and $29,223.33), first-line osimertinib was estimated to be more effective (1.61 QALYs) and more costly ($83,443.14). Relative to the GE-chemotherapy strategy, the incremental cost-effectiveness ratios were $47,873.96 and $71,954.08 per QALY gained with GE-T790M and the osimertinib first-line strategy. The incremental cost-effectiveness ratio for first-line osimertinib versus GE-T790M was estimated to be $83,766.61. The results were found to be robust for univariate and multivariable sensitivity analyses.
Gefitinib or erlotinib first-line and chemotherapy second-line strategies were the most cost-effective first-line treatments for EGFR mutations in patients with NSCLC. Gefitinib or erlotinib first-line and gene-guided osimertinib second-line strategies were more cost-effective than osimertinib first-line treatment for patients who preferred osimertinib administration in China.
本研究旨在评估奥希替尼联合吉非替尼或厄洛替尼作为表皮生长因子受体（EGFR）突变阳性非小细胞肺癌（NSCLC）一线及序贯治疗的成本效果。
采用 Markov 模型，研究包括 10 年 3 个健康状态。转移概率和安全性数据来自 FLAURA（AZD9291 对比吉非替尼或厄洛替尼用于局部晚期或转移性非小细胞肺癌）试验。成本和效用值来自当地费用和文献。进行敏感性分析以观察模型稳定性。
与吉非替尼或厄洛替尼一线治疗和二线基因指导奥希替尼治疗（GE-T790M）相比，吉非替尼或厄洛替尼一线治疗和二线化疗（GE-化疗）策略可获得 0.31 个质量调整生命年（QALY），每位患者的成本增加 15200.95 美元。与 GE-化疗相比，一线奥希替尼治疗的增量 QALY 和增量成本分别为 0.96 和 69420.76 美元。与 GE-T790M 策略（0.96 QALY 和 29223.33 美元）相比，一线奥希替尼治疗被估计更有效（1.61 QALYs）且更昂贵（83443.14 美元）。与 GE-化疗策略相比，GE-T790M 和奥希替尼一线治疗策略的增量成本效果比分别为每获得 1 个 QALY 增加 47873.96 美元和 71954.08 美元。一线奥希替尼与 GE-T790M 相比的增量成本效果比估计为 83766.61 美元。单变量和多变量敏感性分析结果稳健。
吉非替尼或厄洛替尼一线和化疗二线策略是 EGFR 突变 NSCLC 患者最具成本效果的一线治疗方法。对于在中国首选奥希替尼治疗的患者，吉非替尼或厄洛替尼一线和基因指导奥希替尼二线策略比奥希替尼一线治疗更具成本效果。
