OP3 Cost-effectiveness of epidermal growth-factor receptor mutation testing and first-line treatment with gefitinib for advanced non-small-cell lung cancer

Abstract

Background: Epidermal growth-factor receptor (EGFR) testing and first-line therapy with gefitinib is becoming the standard treatment for advanced non-small-cell lung cancer (NSCLC). Yet, to date, no study has quantified the cost-effectiveness of this approach within an Asian population, where the prevalence of activating mutations is higher than among western populations. Methods: A decision-analytic model was developed to determine the cost-effectiveness of EGFR testing and first-line treatment with gefitinib for patients with activating EGFR mutations, versus standard care, which includes first-line treatment with chemotherapy followed by gefitinib as second-line treatment. The model uses clinical and outcomes data from three randomised clinical trials, and societal (non-subsidised) costs from three cancer treatment centres in Singapore. Health effects were expressed as quality-adjusted life-years (QALY) gained. Costs include relevant costs for prescription medications, physician visits, laboratory tests, scans, hospitalisations, and treatment of adverse events. All costs and cost-effectiveness ratios were expressed in 2010 Singapore dollars. Sensitivity analyses were done to identify the extent to which results were robust to key model assumptions. Findings: EGFR testing and first-line treatment with gefitinib was found to be a dominant strategy (lower costs and greater effectiveness) compared with standard care. Because the primary savings in the testing group did not result from not providing gefitinib to patients who do not benefit, this finding holds regardless of the percentage of patients who test positive for EGFR mutation. In a secondary analysis, first-line treatment with gefitinib was also dominant compared with first-line chemotherapy in patients with activating EGFR mutations. Interpretation: Based on these data, EGFR testing and first-line treatment with gefitinib for patients with activating mutations should become a standard treatment in advanced NSLC. Funding: Astra Zeneca provided funds to support this study, which was done independently from the sponsor. Conflicts of interest: All authors receive research funding from AstraZeneca, and T.M. and G.L. received honoraria.