Cost-Effectiveness Analysis of Afatinib versus Gefitinib in Non-small Cell Lung Cancer (NSCLC) with Epidermal Growth Factor Receptor (EGFR) Mutation in Indonesia: Observational studies with Retrospectives

Abstract

Background: A cost effectiveness study is a method in pharmacoeconomic research that can be used as a reference for decision makers or clinicians in determining effective and efficient treatment for patients, one of which is a Non-Small Cell Lung Cancer patient who has an EGFR mutation. Research related to the cost effectiveness of the benefits afatinib and gefitinib is still very limited, especially in Indonesia. This study aims to determine the cost-effectiveness of afatinib versus gefitinib in NSCLC with EGFR mutation patients. Methods and Material: This study is an observational study with a retrospective approach that observes medical record records (to determine clinical outcomes) and financial records (to determine direct medical costs) in NSCLC patients with EGFR mutations at dr Sardjito Hospital Yogyakarta and Dr Kariadi Hospital Semarang, Java Island., Indonesia in the period January 2016 - June 2019. Result: Direct medical cost for NSCLC patients with EGFR mutations who received afatinib therapy was an average of Rp. 120,881,289, - ± 5,353,480.07 per patient, while those who received gefitinib therapy were an average of 90,750,186, - ± 3,369,967,722. Effectiveness data have been published in previous studies. The ICER PFS value shows that afatinib is cost-effectiveness compared to gefitinib with a value of Rp. 106, 345, 069.4/PFS (year). This ICER value is less than 2 times the value of Gross Domestic Product/GDP (Rp. 118, 200,000, -) which is around 1.8 times the value of GDP, whereas in OS afatinib is no better than gefitinib. Conclusion: Afatinib cost effectiveness based on real world retrospectively compared to gefitinib with ICER PFS value of Rp. 106, 345, 069.4/year.