Cost-effectiveness of three strategies for second-line erlotinib initiation in nonsmall-cell lung cancer: the ERMETIC study part 3
- 9 June 2011
- journal article
- research article
- Published by European Respiratory Society (ERS) in European Respiratory Journal
- Vol. 39 (1), 172-179
- https://doi.org/10.1183/09031936.00201210
Abstract
International audienceSeveral clinical and biological parameters are known to influence the efficacy of second-line erlotinib therapy for nonsmall cell lung cancer (NSCLC), but their medico-economic impact has not been evaluated. The objective of this study was to compare the incremental cost-effectiveness ratios of strategies for second-line erlotinib initiation in NSCLC: clinically guided initiation (nonsmoking females with adenocarcinoma received erlotinib; all other patients received docetaxel) and biologically guided selection (patients with epidermal growth factor receptor (EGFR) mutation received erlotinib; patients with wild-type EGFR or unknown status received docetaxel), compared with initiation with no patient selection (strategy reference). A Markov model was constructed. Outcomes (overall and progression-free survival), transition probabilities and direct medical costs (from the French third-party payer's perspective) were prospectively collected for individual patients treated with either erlotinib or docetaxel, from treatment initiation to disease progression. Published data were used to estimate utilities and post-progression costs. Sensitivity analyses were performed. The biologically and clinically guided strategies were both more efficient (incremental quality-adjusted life-yrs equal to 0.080 and 0.081, respectively) and less expensive (cost decrease equal to €5,020 and €5,815, respectively) than the no-selection strategy, and the biologically guided strategy was slightly less expensive than the clinically guided strategy. Sensitivity analyses confirmed the robustness of the results. The cost-effectiveness of second-line NSCLC treatment is improved when patients are selected on either clinical or biological groundsThis publication has 29 references indexed in Scilit:
- Cross-Validation Study for Epidermal Growth Factor Receptor and KRAS Mutation Detection in 74 Blinded Non-small Cell Lung Carcinoma Samples: A Total of 5550 Exons Sequenced by 15 Molecular French Laboratories (Evaluation of the EGFR Mutation Status for the Administration of EGFR-TKIs in Non-Small Cell Lung Carcinoma [ERMETIC] Project—Part 1)Journal of Thoracic Oncology, 2011
- Benefit of Erlotinib in Patients with Non-Small-Cell Lung Cancer Is Related to Smoking Status, Gender, Skin Rash and Radiological Response but Not to Histology and Treatment LineOncology, 2010
- Gefitinib or Carboplatin–Paclitaxel in Pulmonary AdenocarcinomaThe New England Journal of Medicine, 2009
- Economics of Treatments for Non-Small Cell Lung CancerPharmacoEconomics, 2009
- Evaluation of Trends in the Cost of Initial Cancer TreatmentJNCI Journal of the National Cancer Institute, 2008
- Health state utilities for non small cell lung cancerHealth and Quality of Life Outcomes, 2008
- Erlotinib in Previously Treated Non–Small-Cell Lung CancerThe New England Journal of Medicine, 2005
- Erlotinib in Lung Cancer — Molecular and Clinical Predictors of OutcomeThe New England Journal of Medicine, 2005
- Activating Mutations in the Epidermal Growth Factor Receptor Underlying Responsiveness of Non–Small-Cell Lung Cancer to GefitinibThe New England Journal of Medicine, 2004
- Quality of Life and Utility in Patients with Non-Small Cell Lung CancerPharmacoEconomics, 2001