Cost-effectiveness of gefitinib, icotinib, and pemetrexed-based chemotherapy as first-line treatments for advanced non-small cell lung cancer in China

// Shun Lu 1 , Ming Ye 2 , Lieming Ding 3 , Fenlai Tan 3 , Jie Fu 4 , Bin Wu 4 1 Department of Medical Oncology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China 2 Department of Radiotherapy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China 3 Betta Pharmaceuticals Co., Ltd., Hangzhou, China 4 Medical Decision and Economic Group, Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China Correspondence to: Bin Wu, email: wbwithtg@hotmail.com Keywords: gefitinib, icotinib, EGFR mutation, cost-effectiveness, non-small cell lung cancer Received: September 20, 2016     Accepted: December 12, 2016     Published: December 27, 2016 ABSTRACT Tyrosine kinase inhibitors of the epidermal growth factor receptor (EGFR) are becoming the standard treatment option for patients with advanced non-small cell lung cancer (NSCLC) harboring an EGFR mutation, but the economic impact of this practice is unclear, especially in a health resource-limited setting. A decision-analytic model was developed to simulate 21-day patient transitions in a 10-year time horizon. The health and economic outcomes of four first-line strategies (pemetrexed plus cisplatin [PC] alone, PC followed by maintenance with pemetrexed, or initial treatment with gefitinib or icotinib) among patients harboring EGFR mutations were estimated and assessed via indirect comparisons. Costs in the Chinese setting were estimated. The primary outcome was the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed. The icotinib strategy resulted in greater health benefits than the other three strategies in NSCLC patients harboring EGFR mutations. Relative to PC alone, PC followed by pemetrexed maintenance, gefitinib and icotinib resulted in ICERs of $104,657, $28,485 and $19,809 per quality-adjusted life-year gained, respectively. The cost of pemetrexed, the EGFR mutation prevalence and the utility of progression-free survival were factors that had a considerable impact on the model outcomes. When the icotinib Patient Assistance Program was available, the economic outcome of icotinib was more favorable. These results indicate that gene-guided therapy with icotinib might be a more cost-effective treatment option than traditional chemotherapy.