Comparative effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors: Analysis of real-world data in a tertiary hospital in Taiwan

PLoS One. 2020 Apr 8;15(4):e0231413. doi: 10.1371/journal.pone.0231413. eCollection 2020.

Abstract

Introduction: Comparison of the effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors (TKIs) would improve patients' clinical benefits and save costs. Using real-world data, this study attempted to directly compare the effectiveness and cost-effectiveness of first-line afatinib, erlotinib, and gefitinib.

Methods: During May 2011-December 2017, all patients with non-small cell lung cancer (NSCLC) visiting a tertiary center were invited to fill out the EuroQol five-dimension (EQ-5D) questionnaires and World Health Organization Quality of Life, brief version (WHOQOL-BREF), and received follow-ups for survival and direct medical costs. A total of 379 patients with EGFR mutation-positive advanced NSCLC under first-line TKIs were enrolled for analysis. After propensity score matching for the patients receiving afatinib (n = 48), erlotinib (n = 48), and gefitinib (n = 96), we conducted the study from the payers' perspective with a lifelong time horizon.

Results: Patients receiving afatinib had the worst lifetime psychometric scores, whereas the differences in quality-adjusted life expectancy (QALE) were modest. Considering 3 treatments together, afatinib was dominated by erlotinib. Erlotinib had an incremental cost-effectiveness of US$17,960/life year and US$12,782/QALY compared with gefitinib. Acceptability curves showed that erlotinib had 58.6% and 78.9% probabilities of being cost-effective given a threshold of 1 Taiwanese per capita GDP per life year and QALY, respectively.

Conclusion: Erlotinib appeared to be cost-effective. Lifetime psychometric scores may provide additional information for effectiveness evaluation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Afatinib / therapeutic use
  • Aged
  • Carcinoma, Non-Small-Cell Lung / drug therapy*
  • Carcinoma, Non-Small-Cell Lung / economics
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Cost-Benefit Analysis*
  • Erlotinib Hydrochloride / therapeutic use
  • Female
  • Gefitinib / therapeutic use
  • Humans
  • Life Expectancy
  • Lung Neoplasms / drug therapy*
  • Lung Neoplasms / economics
  • Lung Neoplasms / mortality
  • Lung Neoplasms / pathology
  • Male
  • Propensity Score
  • Protein Kinase Inhibitors / therapeutic use*
  • Quality of Life
  • Survival Rate
  • Taiwan
  • Tertiary Care Centers

Substances

  • Protein Kinase Inhibitors
  • Afatinib
  • Erlotinib Hydrochloride
  • Gefitinib

Grants and funding

We are grateful for the following grants from the Ministry of Science and Technology (MOST107-2320-B-006-069 and MOST108-2918-I-006-006 to SCY) and National Cheng Kung University Hospital NCKUH-10902047 to SCY). The study sponsor had no interference with the study design, data collection and analysis, decision to publish, or preparation of the manuscript.