Abstract
BackgroundOur objective is to compare the cost-utility of icotinib and gefitinib for the second-line treatment of advanced non-small cell lung cancer (NSCLC) from the perspective of the Chinese healthcare system.MethodsModel technology was applied to assess the data of randomized clinical trials and the direct medical costs from the perspective of the Chinese healthcare system. Five-year quality-adjusted life years (QALYs) and incremental cost-utility ratios (ICURs) were calculated. One-way and probabilistic sensitivity analyses (PSA) were performed.ResultsOur model suggested that the median progression-free survival (PFS) was 4.2 months in the icotinib group and 3.5 months in the gefitinib group while they were 4.6 months and 3.4 months, respectively, in the trials. The 5-year QALYs was 0.279 in the icotinib group and 0.269 in the gefitinib group, and the according medical costs were $10662.82 and $13127.57. The ICUR/QALY of icotinib versus gefitinib presented negative in this study. The most sensitive parameter to the ICUR was utility of PFS, ranging from $-1,259,991.25 to $-182,296.61; accordingly the icotinib treatment consistently represented a dominant cost-utility strategy.ConclusionsThe icotinib strategy, as a second-line therapy for advanced NSCLC patients in China, is the preferred strategy relative to gefitinib because of the dominant cost-utility. In addition, icotinib shows a good curative effect and safety, resulting in a strong demand for the Chinese market.
Highlights
The epidermal growth factor receptor (EGFR) expressed in the solid tumor of epithelial origin, has been demonstrated as one of the most important oncogenic drivers
Our model suggested that the median progression-free survival (PFS) was 4.2 months in the icotinib group and 3.5 months in the gefitinib group while they were 4.6 months and 3.4 months, respectively, in the trials
The incremental cost-utility ratios (ICURs)/qualityadjusted life years (QALYs) of icotinib versus gefitinib presented negative in this study
Summary
The epidermal growth factor receptor (EGFR) expressed in the solid tumor of epithelial origin, has been demonstrated as one of the most important oncogenic drivers. Treatment with EGFR-tyrosine kinase inhibitors(TKIs) has shown significant survival benefit for advanced NSCLC patients with EGFR(+). Advanced NSCLC with mutated epidermal growth factor receptor have significant responses to EGFR TKIs, it appears to be a significant survival advantage [2,3]. The oral anti-cancer drugs that inhibit EGFR, gefitinib (Iressa) was the first EGFR TKIs used for solid tumor therapy and it had outstanding performance in the clinical treatment of the past[8,9]. We evaluated the cost-utility of icotinib and gefitinib as a second-line treatment for advanced NSCLC by pharmacoeconomics methods. Our objective is to compare the cost-utility of icotinib and gefitinib for the second-line treatment of advanced non-small cell lung cancer (NSCLC) from the perspective of the Chinese healthcare system
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