Pharmacoeconomics Assessment Of Gemcitabine Or Erlotinib Maintenance Therapy For Advanced Non-small-cell Lung Cancer

OBJECTIVESErlotinib and gemcitabine are widely used in clinical practice for non-small cell lung cancer(NSCLC). Recently, a clinical trial has been proved their effectiveness in NSCLC patient, but their costs were too high for government and patient’ family to afford it. Currently, there is no related pharmcoeconomics evaluation reported in the world.The purpose of this paper is to evaluate the cost effectiveness of switch-maintenance erlotinib versus continuation-maintenance gemcitabine from the perspective of Chinese health care system, so Chinese medical decision maker could make applicable choice based on this study. METHODSA Markov model was developed to simulate the sample people of the IFCT-GFPC0502clinical trial, combining with the cost and utility of gemcitabine or erlotinib for Chinese non-small cell lung cancer(NSCLC) patients. The cost was collected from the Chinese health care system perspective, and utility was from reference.Weibull function was used to simulate the overal survival(OS) curve and progression free survival (PFS) curve of the sample people to figure out transition probability of each Markov state.Then, the Markov cycle tree was built in TreeAge Pro2009software, and analysed the result by performing roll back, cohort analysis, cost-effectiveness analysis, micro-simulation analysis, and sensitivity analysis.RESULTSSwitch-maintenance Erlotinib after four cycles cisplatin-gemcitabine first-line chemotherapy in advanced NSCLC spend only82476.73yuan resulting in0.64QALY gained, it is the cheapest and the best effect treatment compared with continuation-maintenance gemcitabine (113654.25yuan/0.6355QALY) and observation (88793.85yuan/0.5352QALY). Compared with observation, continuation-maintenance gemcitabine would increased0.1002QALY gained at an additional cost of24860.40yuan. The incremental cost effectiveness ratio (ICER) for continuation-maintenance gemcitabine and observation is248014.3583yuan/QALY, gemcitabine is not cost-effective choice when compared with Chinese willingness to pay(WTP) threshold (105543yuan/QALY). However, the cost-effectiveness probability is increased with WTP rising. When WTP increased to246267yuan/QALY, the probability would be over50%. On one-way sensitivity analysis, utility of PFS state is the most influential parameter, but it would not change the model result in range of variation.CONCLUSIONThe result suggested that swith-maintencence erlotinib might be a cost-effectiveness treatment for stable disease advanced NSCLC after4cycles cisplatin-gemcitabine. Gemcitabine might not be a cost-effective choice at WTP of105543yuan/QALY unless above105543yuan/QALY such as tianjin province.