Aguilar-Serra J, Gimeno-Ballester V, Pastor-Clerigues A, Milara J, Trigo-Vicente C, Cortijo J
Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain.
Department of Pharmacy, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Expert Rev Pharmacoecon Outcomes Res. 2022 Jun;22(4):637-646. doi: 10.1080/14737167.2022.1987220. Epub 2021 Oct 11.
To evaluate the cost-effectiveness of first-line treatments, such as erlotinib, gefitinib, afatinib, dacomitinib, and osimertinib, for patients diagnosed with stage IIIB/IV NSCLC harboring EGFR mutations.
MATERIALS & METHODS: A partitioned survival model was developed to estimate quality-adjusted life-year (QALY) and incremental cost-effectiveness ratio (ICER) from the perspective of the Spanish National Health System. Two Bayesian NMAs were performed independently, by using the polynomial fraction method to fit Kaplan-Meier curves for overall survival and progression-free survival. Deterministic and probabilistic sensitivity analyses were performed to evaluate the uncertainty.
The ICER was calculated for the four first-line treatments by comparing them with gefitinib, and the ratios obtained were as follows: €166,416/QALY for osimertinib, €183,682/QALY for dacomitinib, €167,554/QALY for afatinib, €36,196/QALY for erlotinib. It was seen that patients who received osimertinib presented higher QALYs (0.49), followed by dacomitinib (0.33), afatinib (0.32), erlotinib (0.31), and gefitinib (0.28).
Gefitinib is the most cost-effective treatment. In terms of QALYs gained, Osimertinib was more effective than all other TKIs. Nevertheless, with a Spanish threshold of €24,000/QALY, the reduction in the acquisition cost of osimertinib will have to be greater than 70%, to obtain a cost-effectiveness alternative.
评估厄洛替尼、吉非替尼、阿法替尼、达可替尼和奥希替尼等一线治疗方案对诊断为携带EGFR突变的IIIB/IV期非小细胞肺癌（NSCLC）患者的成本效益。
建立了一个分区生存模型，从西班牙国家卫生系统的角度估计质量调整生命年（QALY）和增量成本效益比（ICER）。使用多项式分数法独立进行两个贝叶斯网络Meta分析，以拟合总生存期和无进展生存期的Kaplan-Meier曲线。进行确定性和概率敏感性分析以评估不确定性。
通过将四种一线治疗方案与吉非替尼进行比较计算ICER，得到的比值如下：奥希替尼为166,416欧元/QALY，达可替尼为183,682欧元/QALY，阿法替尼为167,554欧元/QALY，厄洛替尼为36,196欧元/QALY。结果显示，接受奥希替尼治疗的患者QALY更高（0.49），其次是达可替尼（0.33）、阿法替尼（0.32）、厄洛替尼（0.31）和吉非替尼（0.28）。
吉非替尼是最具成本效益的治疗方案。就获得的QALY而言，奥希替尼比所有其他酪氨酸激酶抑制剂更有效。然而，以西班牙24,000欧元/QALY的阈值来看，奥希替尼的采购成本降幅必须大于70%，才能成为具有成本效益的替代方案。
