Budget impact of sequential treatment with first-line afatinib versus first-line osimertinib in non-small-cell lung cancer patients with common EGFR mutations

• Published in: The European journal of health economics Vol. 21; no. 6; pp. 931 - 943
• Main Authors: Westerink, Lotte, Nicolai, Jelmer L. J., Samuelsen, Carl, Smit, Hans J. M., Postmus, Pieter E., Griebsch, Ingolf, Postma, Maarten J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer 01.08.2020; Springer Berlin Heidelberg; Springer Nature B.V
• Subjects: Acrylamides - economics; Acrylamides - therapeutic use; Afatinib - economics; Afatinib - therapeutic use; Aged; Aniline Compounds - economics; Aniline Compounds - therapeutic use; Antineoplastic Agents - economics; Antineoplastic Agents - therapeutic use; Budgets; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - economics; Carcinoma, Non-Small-Cell Lung - genetics; Cost control; Cost-Benefit Analysis; Decision Support Techniques; Economic impact; Economic Policy; ErbB Receptors - genetics; Female; Health care; Health Care Costs - statistics & numerical data; Health Care Management; Health Economics; Humans; Impact analysis; Lung cancer; Lung Neoplasms - drug therapy; Lung Neoplasms - economics; Lung Neoplasms - genetics; Lung Neoplasms - pathology; Male; Medicine; Medicine & Public Health; Middle Aged; Mutation; Netherlands; Original Paper; Patients; Pharmacoeconomics and Health Outcomes; Public Finance; Public Health; Quality-Adjusted Life Years; Sensitivity analysis; Targeted cancer therapy; Netherlands; Treatment sequencing; I18; Osimertinib; Budget impact; Afatinib; I15
• ISSN: 1618-7598; 1618-7601
• DOI: 10.1007/s10198-020-01186-9

Background The therapeutic landscape for non-small-cell lung cancer (NSCLC) patients that have common epidermal growth factor receptor (EGFR) mutations has changed radically in the last decade. The availability of these treatment options has an economic impact, therefore a budget impact analysis was performed. Methods A budget impact analysis was conducted from a Dutch healthcare perspective over a 5-year time horizon in EGFR-mutant NSCLC patients receiving first-line afatinib (Gilotrif®) versus first-line osimertinib (Tagrisso®), followed by subsequent treatments. A decision analysis model was constructed in Excel. Scenario analyses and one-way sensitivity analysis were used to test the models' robustness. Results Sequential treatment with afatinib versus first-line treatment with osimertinib showed mean total time on treatment (ToT) of 29.1 months versus 24.7 months, quality-adjusted life months (QALMs) of 20.2 versus 17.4 with mean cost of ϵ108,166 per patient versus ϵ143,251 per patient, respectively. The 5-year total budget impact was ϵ110.4 million for the afatinib sequence versus ϵ158.6 million for the osimertinib sequence, leading to total incremental cost savings of ϵ48.15 million. Conclusions First-line afatinib treatment in patients with EGFR-mutant NSCLC had a lower financial impact on the Dutch healthcare budget with a higher mean ToT and QALM compared to osimertinib sequential treatment.