Thoracic Oncology Unit, Instituto Nacional de Cancerología, San Fernando No. 22, Col. Sección XVI, Del. Tlalpan, CP. 14080, Mexico City, Mexico.
HS Estudios Farmacoeconómicos, Mexico City, Mexico.
BMC Cancer. 2020 Sep 1;20(1):829. doi: 10.1186/s12885-020-07329-8.
Tyrosine-kinase inhibitors (TKIs) have become the cornerstone treatment of patients with non-small cell lung cancer that harbor oncogenic EGFR mutations. The counterpart of these drugs is the financial burden that they impose, which often creates a barrier for accessing treatment in developing countries. The aim if the present study was to compare the cost-effectiveness of three different first and second generation TKIs.
We designed a retrospective cost-effectiveness analysis of three different TKIs (afatinib, erlotinib, and gefitinib) administered as first-line therapy for patients with NSCLC that harbor EGFR mutations.
We included 99 patients with the following TKI treatment; 40 treated with afatinib, 33 with gefitinib, and 26 with erlotinib. Median PFS was not significantly different between treatment groups; 15.4 months (95% CI 9.3-19.5) for afatinib; 9.0 months (95% CI 6.3- NA) for erlotinib; and 10.0 months (95% CI 7.46-14.6) for gefitinib. Overall survival was also similar between groups: 29.1 months (95% CI 25.4-NA) for afatinib; 27.1 months (95% CI 17.1- NA) for erlotinib; and 23.7 months (95% CI 18.6-NA) for gefitinib. There was a statistically significant difference between the mean TKIs costs; being afatinib the most expensive treatment. This difference was observed in the daily cost of treatment (p < 0.01), as well as the total cost of treatment (p = 0.00095). Cost-effectiveness analysis determined that afatinib was a better cost-effective option when compared with first-generation TKIs (erlotinib and gefitinib).
In our population, erlotinib, afatinib, and gefitinib were statistically equally effective in terms of OS and PFS for the treatment of patients with advanced EGFR-mutated NSCLC population. Owing to its marginally increased PFS and OS, the cost-effectiveness analysis determined that afatinib was a slightly better cost-effective option when compared with first-generation TKIs (erlotinib and gefitinib).
酪氨酸激酶抑制剂（TKIs）已成为携带致癌 EGFR 突变的非小细胞肺癌患者的基石治疗方法。这些药物的对应物是它们带来的经济负担，这往往为发展中国家的治疗带来障碍。本研究的目的是比较三种不同的第一代和第二代 TKI 的成本效益。
我们设计了一项回顾性成本效益分析，比较了三种不同的 TKI（阿法替尼、厄洛替尼和吉非替尼）作为 EGFR 突变的非小细胞肺癌患者一线治疗的成本效益。
我们纳入了 99 名接受以下 TKI 治疗的患者；40 名接受阿法替尼治疗，33 名接受吉非替尼治疗，26 名接受厄洛替尼治疗。无进展生存期（PFS）在治疗组之间无显著差异；阿法替尼组为 15.4 个月（95%CI9.3-19.5）；厄洛替尼组为 9.0 个月（95%CI6.3-NA）；吉非替尼组为 10.0 个月（95%CI7.46-14.6）。总生存期（OS）在各组之间也相似：阿法替尼组为 29.1 个月（95%CI25.4-NA）；厄洛替尼组为 27.1 个月（95%CI17.1-NA）；吉非替尼组为 23.7 个月（95%CI18.6-NA）。TKI 治疗的平均成本存在统计学显著差异；阿法替尼是最昂贵的治疗方法。这种差异体现在治疗的每日费用（p<0.01），以及治疗的总费用（p=0.00095）。成本效益分析确定，与第一代 TKI（厄洛替尼和吉非替尼）相比，阿法替尼是一种更好的成本效益选择。
在我们的人群中，厄洛替尼、阿法替尼和吉非替尼在 OS 和 PFS 方面对晚期 EGFR 突变 NSCLC 患者的治疗效果统计学上是等效的。由于其略有增加的 PFS 和 OS，成本效益分析确定，与第一代 TKI（厄洛替尼和吉非替尼）相比，阿法替尼是一种稍微更好的成本效益选择。
