Document Detail


Effectiveness and cost-effectiveness of erlotinib versus gefitinib in first-line treatment of epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancer patients in Hong Kong.
MedLine Citation:
PMID:  24281768     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE. To compare the effectiveness and cost-effectiveness of erlotinib versus gefitinib as first-line treatment of epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancer patients. DESIGN. Indirect treatment comparison and a cost-effectiveness assessment. SETTING. Hong Kong. PATIENTS. Those having epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancer. INTERVENTIONS. Erlotinib versus gefitinib use was compared on the basis of four relevant Asian phase-III randomised controlled trials: one for erlotinib (OPTIMAL) and three for gefitinib (IPASS; NEJGSG; WJTOG). The cost-effectiveness assessment model simulates the transition between the health states: progression-free survival, progression and death, over a life-time horizon. The World Health Organization criterion (incremental cost-effectiveness ratio <3 times of gross domestic product/capita: <US$102 582; approximately <HK$798 078) was used to rate cost-effectiveness. RESULTS. The best fit of study characteristics and prognostic patient characteristics were found between the OPTIMAL and IPASS trials. Comparing progression-free survival hazard ratios of erlotinib versus gefitinib using only these randomised controlled trials in an indirect treatment comparison resulted in a statistically significant progression-free survival difference in favour of erlotinib (indirect treatment comparison hazard ratio=0.33; 95% confidence interval, 0.19-0.58; P=0.0001). The cost-effectiveness assessment model showed that the cost per progression-free life year gained and per quality-adjusted life year gained was at acceptable values of US$39 431 (approximately HK$306 773) and US$62 419 (approximately HK$485 619) for erlotinib versus gefitinib, respectively. CONCLUSION. The indirect treatment comparison of OPTIMAL versus IPASS shows that erlotinib is significantly more efficacious than gefitinib. Furthermore, the cost-effectiveness assessment indicates that the incremental cost-effectiveness ratios are well within an acceptable range in relation to the survival benefits obtained. In conclusion, erlotinib is cost-effective compared to gefitinib for first-line epidermal growth factor receptor-activating mutation-positive non-small-cell lung cancer patients.
Authors:
V Wy Lee; B Schwander; V Hf Lee
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-11-22
Journal Detail:
Title:  Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine     Volume:  -     ISSN:  1024-2708     ISO Abbreviation:  Hong Kong Med J     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-11-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9512509     Medline TA:  Hong Kong Med J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
School of Pharmacy, The Chinese University of Hong Kong, Shatin, Hong Kong.
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