This article was originally published here
Oncol before. December 14, 2021; 11: 564234. doi: 10.3389 / fonc.2021.564234. Electronic collection 2021.
Objectives: To establish the cost-effectiveness of dacomitinib versus gefitinib from the perspective of the Chinese health system.
PATIENTS: Advanced non-small cell lung cancer (NSCLC) with mutations in the epidermal growth factor receptor (EGFR).
METHODS: A partitioned survival analysis was undertaken to examine the cost-effectiveness of dacomitinib using individual patient data (IPD) from the pivotal randomized controlled trial (RCT) (ARCHER 1050). The three health states modeled were progression-free, post-progression, and death. Parametric survival distributions were fitted to the IPD against Kaplan-Meier survival curves corresponding to progression-free survival (PFS) and overall survival (OS) results by randomized groups. The costs included the acquisition and administration of drugs, outpatient management (outpatient consultation and examinations) and the best supportive care costs. Utility weights are taken from the Pivotal Test and other publications. The incremental cost-effectiveness ratio (ICER) was calculated with costs and quality-adjusted life years (QALY) discounted at an annual rate of 5%. Both deterministic and probabilistic sensitivity analyzes were undertaken.
RESULTS: In the base case, dacomitinib (265,512 CNY and 1.95 QALY) was associated with higher QALY costs and gains than gefitinib (247,048 CNY and 1.61 QALY), resulting in a ICER of 58,947 CNY / QALY. Using the empirical WTP / QALY cutoff, dacomitinib is a cost-effective treatment strategy for patients with advanced NSCLC with positive EGFR mutation. Probabilistic sensitivity analysis suggested that dacomitinib had a 97% chance of being cost-effective.
CONCLUSIONS: Dacomitinib is a cost-effective treatment strategy for the treatment of patients with EGFR-positive NSCLC from the perspective of the Chinese health system. The uncertainty surrounding the cost-effectiveness of dacomitinib may be reduced if long-term survival data become available.
CLINICAL TRIAL REGISTRATION: NCT01024413.