Cost-Effectiveness Analysis Of Erlotinib Versus CG Chemotherapy In NSCLC First-line Therapy

ObjectiveOur study compared cost-effectiveness between erlotinib monotherapy and carboplatin-gemcitabine (CG) combination therapy in patients with advanced EGFR mutation-positive NSCLC to provide a valuable reference for rational、safe and economic use of anticancer drug.MethodsThis study was based on the data and information from a phase Ⅲ clinical trials (the OPTIMAL trial) and a large3A grade hospital. From the perspective of the Chinese health care system, comparing cost effectiveness between erlotinib monotherapy and carboplatin plus gemcitabine (CG) combination therapy in patients with advanced EGFR mutation-positive NSCLC. Incremental cost effectiveness ratios (ICER) was used as evaluation indicator. Markov model was used to analyse data and TreeAge Pro2009was used to establish the model and export outcomes with all necessary data. To allow for uncertainties within the parameters and to estimate the model robustness, one-way sensitivity analysis and probabilistic sensitivity analysis were performed.ResultsThe median progression-free survival (PFS) obtained from Markov model was13.2months (13.1months was reported in the trial) in the erlotinib group while and4.64months (4.6months was reported in the trial) in the CG group. The QALYs were1.4years in the erlotinib group and1.96years in the CG group.One-way sensitivity analysis outcomes suggested that ICER was most sensitive to the health utility of DP. Probabilistic sensitivity analysis outcomes suggested that erlotinib alone as the first-line therapy is cost-effective at the WTP threshold of$13146compared to carboplatin-gemcitabine combination therapy.ConclusionFrom the perspective of the Chinese health care system, compared with platinum-based doublets chemotherapy, erlotinib monotherapy failed to prolong the survival of patients, but it significantly reduced the rate of serious adverse events and improved the quality of patients. Therefore, erlotinib monotherapy is cost-effective as a first-line therapy for advanced EGFR mutation-positive NSCLC patients.