Please use this identifier to cite or link to this item: https://doi.org/10.1186/s12885-018-4223-y
Title: Cost effectiveness analysis of afatinib versus pemetrexed-cisplatin for first-line treatment of locally advanced or metastatic EGFR mutation positive non-small-cell lung cancer from the Singapore healthcare payer's perspective
Authors: Tan, P.-T
Aziz, M.I.A
Pearce, F
Lim, W.-T 
Wu, D.B.-C
Ng, K
Keywords: afatinib
cisplatin
epidermal growth factor receptor
pemetrexed
afatinib
antineoplastic agent
cisplatin
epidermal growth factor receptor
pemetrexed
advanced cancer
Article
cancer chemotherapy
cancer growth
comparative effectiveness
controlled study
cost effectiveness analysis
death
drug cost
drug effect
drug efficacy
drug response
drug safety
EGFR gene
gene mutation
human
major clinical study
medical decision making
multiple cycle treatment
non small cell lung cancer
overall survival
phase 3 clinical trial
progression free survival
quality of life
randomized controlled trial
sensitivity analysis
Singapore
survival rate
treatment outcome
cancer staging
clinical trial
cost benefit analysis
genetics
health care cost
lung tumor
metastasis
mortality
mutation
non small cell lung cancer
pathology
prognosis
Afatinib
Antineoplastic Combined Chemotherapy Protocols
Carcinoma, Non-Small-Cell Lung
Cisplatin
Cost-Benefit Analysis
ErbB Receptors
Health Care Costs
Humans
Lung Neoplasms
Mutation
Neoplasm Metastasis
Neoplasm Staging
Pemetrexed
Prognosis
Singapore
Treatment Outcome
Issue Date: 2018
Citation: Tan, P.-T, Aziz, M.I.A, Pearce, F, Lim, W.-T, Wu, D.B.-C, Ng, K (2018). Cost effectiveness analysis of afatinib versus pemetrexed-cisplatin for first-line treatment of locally advanced or metastatic EGFR mutation positive non-small-cell lung cancer from the Singapore healthcare payer's perspective. BMC Cancer 18 (1) : 352. ScholarBank@NUS Repository. https://doi.org/10.1186/s12885-018-4223-y
Rights: Attribution 4.0 International
Abstract: Background: Non-small-cell lung cancer (NSCLC) accounts for 85% of all lung cancers and is associated with a poor prognosis. Afatinib is an irreversible ErbB family blocker recommended in clinical guidelines as a first-line treatment for NSCLC which harbours an epidermal growth factor receptor (EGFR) mutation. The objective of this study was to evaluate the cost-effectiveness of afatinib versus pemetrexed-cisplatin for first-line treatment of locally advanced or metastatic EGFR mutation positive NSCLC in Singapore. Methods: A partitioned survival model with three health states (progression-free, progressive disease and death) was developed from a healthcare payer perspective. Survival curves from the LUX-Lung 3 trial (afatinib versus pemetrexed-cisplatin chemotherapy) were extrapolated beyond the trial period to estimate the underlying progression-free survival and overall survival parametric distributions. Rates of adverse reactions were also estimated from LUX-Lung 3 while health utilities from overseas were derived from the literature in the absence of local estimates. Direct costs were sourced from public healthcare institutions in Singapore. Incremental cost-effectiveness ratios (ICERs) were calculated over a 5 year time horizon. Deterministic and probabilistic sensitivity analyses and additional scenario analyses were conducted to explore the impact of uncertainties and assumptions on the cost-effectiveness results. Results: In the base-case analysis, the ICER for afatinib versus pemetrexed-cisplatin was SG$137,648 per quality-adjusted life year (QALY) gained and SG$109,172 per life-year gained. One-way sensitivity analysis showed the ICER was most sensitive to variations in the utility values, the cost of afatinib and time horizon. Scenario analyses showed that even reducing the cost of afatinib by 50% led to a high ICER which was unlikely to represent a cost-effective use of healthcare resources. Conclusions: Compared with pemetrexed-cisplatin, afatinib is not cost-effective as a first-line treatment for advanced EGFR mutation-positive NSCLC in Singapore. The findings from our study will be useful to inform local healthcare decision-making and resource allocations for NSCLC treatments, together with other considerations such as clinical effectiveness, safety and affordability of TKIs. © 2018 The Author(s).
Source Title: BMC Cancer
URI: https://scholarbank.nus.edu.sg/handle/10635/181206
ISSN: 14712407
DOI: 10.1186/s12885-018-4223-y
Rights: Attribution 4.0 International
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