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

Hong Kong Med J. 2014 Jun;20(3):178-86. doi: 10.12809/hkmj133986. Epub 2013 Nov 22.

Abstract

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 lifetime 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.

Keywords: Antineoplastic agents; Carcinoma, non-small-cell lung; Cost-benefit analysis; Lung neoplasms.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Non-Small-Cell Lung / drug therapy*
  • Carcinoma, Non-Small-Cell Lung / genetics
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Clinical Trials, Phase III as Topic
  • Cost-Benefit Analysis
  • ErbB Receptors / genetics*
  • Erlotinib Hydrochloride
  • Female
  • Gefitinib
  • Humans
  • Lung Neoplasms / drug therapy*
  • Lung Neoplasms / genetics
  • Lung Neoplasms / mortality
  • Male
  • Middle Aged
  • Mutation*
  • Protein Kinase Inhibitors / economics
  • Protein Kinase Inhibitors / therapeutic use*
  • Quinazolines / economics
  • Quinazolines / therapeutic use*

Substances

  • Protein Kinase Inhibitors
  • Quinazolines
  • Erlotinib Hydrochloride
  • ErbB Receptors
  • Gefitinib