Cost-effectiveness analysis of EGFR mutation testing in patients with non-small cell lung cancer (NSCLC) with gefitinib or carboplatin–paclitaxel

• Published in: The European journal of health economics Vol. 17; no. 7; pp. 855 - 863
• Main Authors: Arrieta, Oscar, Anaya, Pablo, Morales-Oyarvide, Vicente, Ramírez-Tirado, Laura Alejandra, Polanco, Ana C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer 01.09.2016; Springer Berlin Heidelberg; Springer Nature B.V
• Subjects: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols - economics; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer therapies; Carboplatin - therapeutic use; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - genetics; Chemotherapy; Clinical trials; Cost analysis; Cost benefit analysis; Cost effectiveness analysis; Cost efficiency; Developing countries; Disease-Free Survival; Economic Policy; Female; Genes, erbB-1 - genetics; Genetic mutation; Growth factor receptors; Health Care Management; Health care policy; Health Economics; Health policy; Humans; Kinases; Latin America; LDCs; Lung cancer; Lung neoplasms; Lung Neoplasms - drug therapy; Lung Neoplasms - genetics; Male; Medical prognosis; Medicine; Medicine & Public Health; Mexico; Models, Econometric; Mutation; Original Paper; Paclitaxel - therapeutic use; Patients; Pharmacoeconomics and Health Outcomes; Protein Kinase Inhibitors - economics; Protein Kinase Inhibitors - therapeutic use; Public Finance; Public Health; Quality of life; Quality-Adjusted Life Years; Quinazolines - economics; Quinazolines - therapeutic use; Sensitivity analysis; Simulations; Statistical analysis; Mexico; I18; Carcinoma; Health policy; M1; Developing countries; I11; I; Mutation; Non-small-cell lung; Cost–benefit analysis
• ISSN: 1618-7598; 1618-7601
• DOI: 10.1007/s10198-015-0726-5

Objective Assess the cost-effectiveness of an EGFR-mutation testing strategy for advanced NSCLC in first-line therapy with either gefitinib or carboplatin-paclitaxel in Mexican institutions. Methods Cost-effectiveness analysis using a discrete event simulation (DES) model to simulate two therapeutic strategies in patients with advanced NSCLC. Strategy one included patients tested for EGFR-mutation and therapy given accordingly. Strategy two included chemotherapy for all patients without testing. All results are presented in 2014 US dollars. The analysis was made with data from the Mexican frequency of EGFR-mutation. A univariate sensitivity analysis was conducted on EGFR prevalence. Progression-free survival (PFS) transition probabilities were estimated on data from the IPASS and simulated with a Weibull distribution, run with parallel trials to calculate a probabilistic sensitivity analysis. Results PFS of patients in the testing strategy was 6.76 months (95 % CI 6.10-7.44) vs 5.85 months (95 % CI 5.43-6.29) in the non-testing group. The one-way sensitivity analysis showed that PFS has a direct relationship with EGFR-mutation prevalence, while the ICER and testing cost have an inverse relationship with EGFR-mutation prevalence. The probabilistic sensitivity analysis showed that all iterations had incremental costs and incremental PFS for strategy 1 in comparison with strategy 2. Conclusion There is a direct relationship between the ICER and the cost of EGFR testing, with an inverse relationship with the prevalence of EGFR-mutation. When prevalence is >10 % ICER remains constant. This study could impact Mexican and Latin American health policies regarding mutation detection testing and treatment for advanced NSCLC.