Nargesi Shahin, Dolatshahi Zeinab, Rezapour Aziz, Alipour Vahid, Souresrafil Aghdas, Farabi Hiro, Javadmoosavi Seyed Arash, Safakhah Mandana, Moradi Najmeh
Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Science, Tehran, Iran.
Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Expert Rev Pharmacoecon Outcomes Res. 2022 Jun;22(4):543-554. doi: 10.1080/14737167.2022.2011721. Epub 2021 Dec 12.
The most common type of lung cancer is advanced and mutant non-small cell lung cancer (NSCLC). Although targeted tyrosine kinase inhibitors (TKIs) have reconstructed the care of these patients, the resistance of TKIs to the secondary EGFR-T790M mutation in advanced or metastatic NSCLC led to the introduction of the third generation of them, like osimertinib. Osimertinib has represented a remarkable increase in progression-free survival (PFS) and a decrease in death and hazard ratios in patients with required T790 mutation and sensitizing EGFR mutation without T790M. We aimed to evaluate the cost-effectiveness of osimertinib for the treatment of these patients compared to chemotherapy or immunotherapy with the last generations of EGFR-TKIs.
Electronic searches were conducted on PubMed, Embase, Science Direct, Scopus, , Web of Knowledge, NHSEED, NHS Health Technology assessment (CRD), and Cost-Effectiveness Analysis Registry databases. Related articles were reviewed from January 2015 to the end of August 2020. Out of 2708 initial studies, 10 articles had the inclusion criteria.
Although osimertinib improves the quality of life and PFS for the mentioned patients based on its greater efficacy compared to standard EGFR-TKIs and chemotherapy, its high cost prevents considering it a cost-effective option. And, since most entered studies have been done in developed countries, it certainly does not true to extend these results to low-income and developing countries. Therefore, further studies in those countries are needed to evaluate the cost-effectiveness of osimertinib for sensitizing EGFR mutation without T790M and required T790M in advanced or metastatic NSCLC.
最常见的肺癌类型是晚期和突变型非小细胞肺癌（NSCLC）。尽管靶向酪氨酸激酶抑制剂（TKIs）已经重塑了这些患者的治疗方式，但TKIs对晚期或转移性NSCLC中继发的EGFR-T790M突变产生的耐药性促使了第三代TKIs的出现，如奥希替尼。对于有T790突变且无T790M的敏感EGFR突变患者，奥希替尼显著延长了无进展生存期（PFS），并降低了死亡率和风险比。我们旨在评估与化疗或上一代EGFR-TKIs免疫疗法相比，奥希替尼治疗这些患者的成本效益。
在PubMed、Embase、Science Direct、Scopus、Web of Knowledge、NHSEED、NHS卫生技术评估（CRD）和成本效益分析注册数据库中进行了电子检索。对2015年1月至2020年8月底的相关文章进行了综述。在2708项初始研究中，有10篇文章符合纳入标准。
尽管与标准EGFR-TKIs和化疗相比，奥希替尼疗效更佳，提高了上述患者的生活质量和PFS，但其高昂的成本使其无法被视为具有成本效益的选择。而且，由于大多数纳入研究是在发达国家进行的，将这些结果推广到低收入和发展中国家肯定是不现实的。因此，需要在这些国家进行进一步研究，以评估奥希替尼对晚期或转移性NSCLC中无T790M的敏感EGFR突变和有T790M突变患者的成本效益。
