Cost-effectiveness of three strategies for second-line erlotinib initiation in nonsmall-cell lung cancer: the ERMETIC study part 3

• Published in: The European respiratory journal Vol. 39; no. 1; pp. 172 - 179
• Main Authors: Borget, I., Cadranel, J., Pignon, J-P., Quoix, E., Coudert, B., Westeel, V., Dansin, E., Madelaine, J., Madroszyk, A., Friard, S., Daniel, C., Morin, F., Chouaid, C.
• Format: Journal Article
• Language: English
• Published: Leeds Maney 01.01.2012; European Respiratory Society
• Subjects: Aged; Biological and medical sciences; Cancer; Carcinoma, Non-Small-Cell Lung; Carcinoma, Non-Small-Cell Lung - drug therapy; Cost-Benefit Analysis; ErbB Receptors; Erlotinib Hydrochloride; Female; Humans; Life Sciences; Lung Neoplasms; Lung Neoplasms - drug therapy; Male; Markov Chains; Medical Oncology; Medical Oncology - economics; Medical Oncology - methods; Medical sciences; Middle Aged; Mutation; Pneumology; Protein Kinase Inhibitors; Protein Kinase Inhibitors - economics; Protein Kinase Inhibitors - therapeutic use; Quality of Life; Quinazolines; Quinazolines - economics; Quinazolines - therapeutic use; Receptor, Epidermal Growth Factor - genetics; Sensitivity and Specificity; Tumors of the respiratory system and mediastinum; Lung disease; Costs; Respiratory disease; Lung cancer; nonsmall cell lung cancer; Malignant tumor; Cost-utility; EGFR mutation; Erlotinib; Health economy; Bronchus disease; Strategy; Mutation; Cell; Initiation; Public health; Cancer; Pneumology
• ISSN: 0903-1936; 1399-3003; 1399-3003
• DOI: 10.1183/09031936.00201210

Several clinical and biological parameters are known to influence the efficacy of second-line erlotinib therapy for nonsmall cell lung cancer (NSCLC), but their medico-economic impact has not been evaluated. The objective of this study was to compare the incremental cost-effectiveness ratios of strategies for second-line erlotinib initiation in NSCLC: clinically guided initiation (nonsmoking females with adenocarcinoma received erlotinib; all other patients received docetaxel) and biologically guided selection (patients with epidermal growth factor receptor ( EGFR ) mutation received erlotinib; patients with wild-type EGFR or unknown status received docetaxel), compared with initiation with no patient selection (strategy reference). A Markov model was constructed. Outcomes (overall and progression-free survival), transition probabilities and direct medical costs (from the French third-party payer's perspective) were prospectively collected for individual patients treated with either erlotinib or docetaxel, from treatment initiation to disease progression. Published data were used to estimate utilities and post-progression costs. Sensitivity analyses were performed. The biologically and clinically guided strategies were both more efficient (incremental quality-adjusted life-yrs equal to 0.080 and 0.081, respectively) and less expensive (cost decrease equal to €5,020 and €5,815, respectively) than the no-selection strategy, and the biologically guided strategy was slightly less expensive than the clinically guided strategy. Sensitivity analyses confirmed the robustness of the results. The cost-effectiveness of second-line NSCLC treatment is improved when patients are selected on either clinical or biological grounds.