Epidermal Growth Factor Receptor Mutation Testing in Thailand: A Cost-Utility Analysis

Objective: To evaluate the cost utility of epidermal growth factor receptor (EGFR) testing plus first-line gefitinib treatment in patients with activating EGFR mutations in Thailand. Methods: The study used a decision tree model considering the provider’s perspective. Direct medical costs were included and based on a local Thai database. Effectiveness was measured as quality-adjusted life-year and based on randomized controlled trials. Incremental cost-effectiveness ratio was calculated and presented in 2012. A series of one-way sensitivity analyses were conducted. Results: We found that the EGFR testing plus first-line gefitinib alternative gained 0.03 quality-adjusted life-year more, but 62,540 Thailand baht (US $2082.58) less total costs compared with the no-testing alternative. The results were robust when varying most variables in the model except for the duration of gefitinib treatment with activating EGFR mutation, the duration of chemotherapy treatment with activating EGFR mutation, and the utility of second-line chemotherapy. Conclusions: EGFR testing should be considered before administering EGFR tyrosine-kinase inhibitor such as gefitinib as first-line treatment in patients with non–small cell lung cancer in Thailand where the incidence of EGFR mutation is high.