Cost-utility Analysis of Afatinib and Gefitinib in First-line Treatment of EGFR Mutation-positive Non-small Cell Lung Cancer

OBJECTIVE To evaluate the cost-utility of afatinib and gefitinib in the first-line treatment of epidermal growth factor receptor(EGFR) mutation-positive non-small cell lung cancer from the perspective of Chinese health care payers. METHODS Based on a high-quality, multicenter, phase 2 randomized clinical trial(LUNG7), a three-state Markov model(no progression survival status, disease progression status, death status) was established based on disease progression. The state transition probability and the incidence of adverse drug reaction were extracted and calculated from clinical trial data. The utility values were taken from the Chinese population utility values in the research literature. Direct medical costs were taken from local fees or related literature. A 10-year cost-utility assessment was performed in total population. Sensitivity analysis was performed on the stability of the model analysis results. RESULTS In the basic analysis, the afatinib group spent more 16 499.77 and received an additional 0.29 quality-adjusted life years(QALYs) relative to the gefitinib group. The incremental cost-effectiveness ratio(ICER) of the afatinib regimen and gefitinib regimen in the general population was 57 428.17/QALY which was much higher than the Chinese willingness to pay threshold(WTP) of 26 331/QALY. It indicated that afatinib had no economic advantage currently. Sensitivity analysis showed that the utility value of the stage of disease progression, the price of gefitinib and afatinib, and the utility of progression-free disease had a greater impact on the stability of the results. However, expect for the price of gefitinib, non of those variables could make the ICER lower than the WTP. It indicated robustness of the model. CONCLUSION For patients with EFGR mutation-positive non-small cell lung cancer in China, afatinib is not economical compared to gefitinib in first-line treatment.