Modelled Economic Analysis for Dacomitinib-A Cost Effectiveness Analysis in Treating Patients With EGFR-Mutation-Positive Non-Small Cell Lung Cancer in China

Yong-Feng Yu, Luan Luan, Fan-Fan Zhu, Peng Dong, Li-Heng Ma, Lan-Ting Li, Lan Gao, Shun Lu, Yong-Feng Yu, Luan Luan, Fan-Fan Zhu, Peng Dong, Li-Heng Ma, Lan-Ting Li, Lan Gao, Shun Lu

Abstract

Objectives: To establish the cost-effectiveness of dacomitinib compared to gefitinib from the Chinese healthcare system perspective.

Patients: Advanced non-small cell lung cancer (NSCLC) harbouring epidermal growth factor receptor (EGFR) mutations.

Methods: Partitioned survival analysis was undertaken to examine the cost-effectiveness of dacomitinib utilising individual patient data (IPD) from the pivotal randomised controlled trial (RCT) (ARCHER 1050). The three health states modelled were progression-free, post-progression, and death. Parametric survival distributions were fitted to IPD against the Kaplan-Meier survival curves corresponding to progression-free survival (PFS) and overall survival (OS) outcomes by randomised groups. Costs included drug acquisition and administration, outpatient management (outpatient consultation and examinations), and best supportive care costs. Utility weights were sourced from the pivotal trial and other published literature. The incremental cost-effectiveness ratio (ICER) was calculated with costs and quality-adjusted life years (QALYs) discounted at an annual rate of 5%. Both deterministic and probabilistic sensitivity analyses were undertaken.

Results: In the base case, dacomitinib (CNY 265,512 and 1.95 QALY) was associated with higher costs and QALY gains compared to gefitinib (CNY 247,048 and 1.61 QALYs), resulting in an ICER of CNY 58,947/QALY. Using the empirical WTP/QALY threshold, dacomitinib is a cost-effective treatment strategy for patients with EGFR-mutation-positive advanced NSCLC. The probabilistic sensitivity analysis suggested that dacomitinib had a 97% probability of being cost-effective.

Conclusions: Dacomitinib is a cost-effective treatment strategy in treating patients with EGFR-mutation-positive NSCLC from the Chinese healthcare system perspective. The uncertainty around the cost-effectiveness of dacomitinib could be reduced if long-term survival data become available.

Clinical trial registration: NCT01024413.

Keywords: NSCLC; cost-effectiveness analysis (CEA); economic model; epidermal growth factor receptor (EGFR) mutations; partitioned survival analysis.

Conflict of interest statement

LL, F-FZ, PD, and L-HM are employees of Pfizer China. L-TL was employed by Shanghai PalanDataRx Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Yu, Luan, Zhu, Dong, Ma, Li, Gao and Lu.

Figures

Figure 1
Figure 1
Parametric Fitting (Weibull) Compared to Observed KM Data: PFS (based on independent review committee) and OS for dacomitinib (upper) and gefitinib (lower). PFS, progression-free survival; OS, overall survival; KM, Kaplan-Meier.
Figure 2
Figure 2
Tornado diagram for the one-way sensitivity analysis. MRU, medical resource use; tx, treatment; OS, overall survival; PFS, progression-free survival; PPS, post-progression survival. The lower values were not tested for the dacomitinib OS parameters and its unit cost due to the negative ICER generated.
Figure 3
Figure 3
Incremental cost-effectiveness plane: Dacomitinib vs. gefitinib. The probability of dacomitinib being cost-effective is 97%.
Figure 4
Figure 4
Cost-effectiveness acceptability curve.

References

    1. World Health Organisation . Latest Global Cancer Data: Cancer Burden Rises to 18.1 Million New Cases and 9.6 Million Cancer Deaths in 2018. Available at: .
    1. Hong QY, Wu GM, Qian GS, Hu CP, Zhou JY, Chen LA, et al. . Prevention and Management of Lung Cancer in China. Cancer (2015) 121(Suppl 17):3080–8. doi: 10.1002/cncr.29584
    1. Chen W, Sun K, Zheng R, Zeng H, Zhang S, Xia C, et al. . Cancer Incidence and Mortality in China, 2014. Chin J Cancer Res (2018) 30(1):1–12. doi: 10.21147/j.issn.1000-9604.2018.01.01
    1. Chen WQ, Zheng RS, Zeng HM, Zhang SW, He J. Annual Report on Status of Cancer in China, 2011. Chin J Cancer Res (2015) 27:2–12. doi: 10.1186/s40880-015-0001-2
    1. Fan S, Mao Z, Lee AH, Teh-wei H. Economic Costs of Lung Cancer in China. Int J Oncol Res (2018) 1:007. doi: 10.23937/ijor-2017/1710007
    1. Ha SY, Choi S-J, Cho JH, Choi HJ, Lee J, Jung K, et al. . Lung Cancer in Never-Smoker Asian Females Is Driven by Oncogenic Mutations, Most Often Involving EGFR. Oncotarget (2015) 6(7):5465–74. doi: 10.18632/oncotarget.2925
    1. Rosell R, Moran T, Queralt C, Porta R, Cardenal F, Camps C, et al. . Screening for Epidermal Growth Factor Receptor Mutations in Lung Cancer. N Engl J Med (2009) 361(10):958–67. doi: 10.1056/NEJMoa0904554
    1. Ettinger DS, Wood DE, Akerley W, Bazhenova LA, Borghaei H, Camidge DR, et al. . Non-Small Cell Lung Cancer, Version 6.2015. J Natl Compr Canc Netw (2015) 13(5):515–24. doi: 10.6004/jnccn.2015.0071
    1. Sandelin M, Berglund A, Sundstrom M, Micke P, Ekman S, Bergqvist M, et al. . Patients With Non-Small Cell Lung Cancer Analyzed for EGFR: Adherence to Guidelines, Prevalence and Outcome. Anticancer Res (2015) 35(7):3979–85 Available at: .
    1. Ramalingam SS, Vansteenkiste J, Planchard D, et al. . Overall Survival With Osimertinib in Untreated, EGFR-Mutated Advanced NSCLC. New Engl J Med (2019) 382:41–50. doi: 10.1056/NEJMoa1913662
    1. Wu YL, Cheng Y, Zhou XD, Lee KH, Nakagawa K, Niho S, et al. . Dacomitinib Versus Gefitinib as First-Line Treatment for Patients With EGFR-Mutation-Positive Non-Small-Cell Lung Cancer (ARCHER 1050): A Randomised, Open-Label, Phase 3 Trial. Lancet Oncol (2017) 18(11):1454–66. doi: 10.1016/S1470-2045(17)30608-3
    1. Cole BF, Gelber RD, Anderson KM. Parametric Approaches to Quality-Adjusted Survival Analysis. International Breast Cancer Study Group. Biometrics (1994) 50(3):621–31. doi: 10.2307/2532777
    1. Goldhirsch A, Gelber RD, Simes RJ, Glasziou P, Coates AS. Costs and Benefits of Adjuvant Therapy in Breast Cancer: A Quality-Adjusted Survival Analysis. J Clin Oncol (1989) 7:36–44. doi: 10.1200/JCO.1989.7.1.36
    1. Glasziou PP, Cole BF, Gelber RD, Hilden J, Simes RJ. Quality Adjusted Survival Analysis With Repeated Quality of Life Measures. Stat Med (1998) 17:1215–29. doi: 10.1002/(SICI)1097-0258(19980615)17:11<1215::AID-SIM844>;2-Y
    1. Glasziou PP, Simes RJ, Gelber RD. Quality Adjusted Survival Analysis. Stat Med (1990) 9:1259–76. doi: 10.1002/sim.4780091106
    1. NICE DSU Technical Support Document 14. Undertaking Survival Analysis for Economic Evaluations Alongside Clinical Trials - Extrapolation With Patient-Level Data (2011). Available at: .
    1. Williams C, Lewsey JD, Mackay DF, Briggs AH. Estimation of Survival Probabilities for Use in Cost-Effectiveness Analyses: A Comparison of a Multi-State Modeling Survival Analysis Approach With Partitioned Survival and Markov Decision-Analytic Modeling. Med Decis Making (2017) 37:427–39. doi: 10.1177/0272989X16670617
    1. Pharmaceutical Benefits Advisory Committee Australia . Public Summary Pharmaceutical Benefits Advisory Committe (PBAC) Meeting. Osimertinib (2018). Available at: .
    1. Krawczyk P, Kowalski DM, Ramlau R, et al. . Comparison of the Effectiveness of Erlotinib, Gefitinib, and Afatinib for Treatment of Non-Small Cell Lung Cancer in Patients With Common and Rare EGFR Gene Mutations. Oncol Lett (2017) 13:4433–44. doi: 10.3892/ol.2017.5980
    1. National Bureau of Statistics of China. National Data 2018; (2018).
    1. Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press; (1995).
    1. Pignata M, Luciani L, McConnachie C, Chouaid C, Roze S, Lay KLE. Cost-Effectiveness of Afatinib Versus Erlotinib for the Treatment of Squamous Non-Small Cell Lung Cancer in France After a First-Line Platinum Based Therapy. Eur Respir J (2017) 50. doi: 10.1183/1393003.congress-2017.PA2795
    1. Park K, Tan EH, O’Byrne K, Zhang L, Boyer M, Mok T, et al. . Afatinib Versus Gefitinib as First-Line Treatment of Patients With EGFR Mutation-Positive Non-Small-Cell Lung Cancer (LUX-Lung 7): A Phase 2B, Open-Label, Randomised Controlled Trial. Lancet Oncol (2016) 17:577–89. doi: 10.1016/S1470-2045(16)30033-X
    1. Tan PT, Aziz MIA, Pearce F, Lim WT, Wu DB, Ng K. 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 (2018) 18:352. doi: 10.1186/s12885-018-4223-y
    1. Pignata M, Le Lay K, Luciani L, McConnachie C, Gordon J, Chouaid C, et al. . Cost-Effectiveness of Afatinib Versus Erlotinib for the Treatment of Squamous Non-Small Cell Lung Cancer in France After a First-Line Platinum Based Therapy. Ann Oncol (2017) 28. doi: 10.1183/1393003.congress-2017.PA2795
    1. Lu S, Ye M, Ding L, Tan F, Fu J, Wu B. Cost-Effectiveness of Gefitinib, Icotinib, and Pemetrexed-Based Chemotherapy as First-Line Treatments for Advanced Non-Small Cell Lung Cancer in China. Oncotarget (2017) 8:9996–10006. doi: 10.18632/oncotarget.14310
    1. Li X, Li W, Hou L. A Trial-Based Cost-Effectiveness Analysis of Bevacizumab and Chemotherapy Versus Chemotherapy Alone for Advanced Nonsquamous Non–Small-Cell Lung Cancer in China. Value Health Regional Issues (2019) 18:1–7. doi: 10.1016/j.vhri.2018.05.001
    1. Peng Z, Hou X, Huang Y, Xie T, Hua X. Cost-Effectiveness Analysis of Fruquintinib for Metastatic Colorectal Cancer Third-Line Treatment in China. BMC Cancer (2020) 20:990. doi: 10.1186/s12885-020-07486-w
    1. Liang H, Song X, Zhang Y, Zhang S, Li F, Fang J, et al. . Real-World Data on EGFR/ALK Gene Status and First-Line Targeted Therapy Rate in Newly Diagnosed Advanced Non-Small Cell Lung Cancer Patients in Northern China: A Prospective Observational Study. Thorac Cancer (2019) 10:1521–32. doi: 10.1111/1759-7714.13090
    1. Soo RA, Loh M, Mok TS, Ou SH, Cho BC, Yeo WL, et al. . Ethnic Differences in Survival Outcome in Patients With Advanced Stage Non-Small Cell Lung Cancer: Results of a Meta-Analysis of Randomized Controlled Trials. J Thorac Oncol (2011) 6:1030–8. doi: 10.1097/JTO.0b013e3182199c03

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться