| Title |
Cost effectiveness analysis of afatinib versus pemetrexed-cisplatin for first-line treatment of locally advanced or metastatic EGFR mutation positive non-small-cell lung cancer from the Singapore healthcare payer’s perspective
|
|---|---|
| Published in |
BMC Cancer, March 2018
|
| DOI | 10.1186/s12885-018-4223-y |
| Pubmed ID | |
| Authors |
Ping-Tee Tan, Mohamed Ismail Abdul Aziz, Fiona Pearce, Wan-Teck Lim, David Bin-Chia Wu, Kwong Ng |
| Abstract |
Non-small-cell lung cancer (NSCLC) accounts for 85% of all lung cancers and is associated with a poor prognosis. Afatinib is an irreversible ErbB family blocker recommended in clinical guidelines as a first-line treatment for NSCLC which harbours an epidermal growth factor receptor (EGFR) mutation. The objective of this study was to evaluate the cost-effectiveness of afatinib versus pemetrexed-cisplatin for first-line treatment of locally advanced or metastatic EGFR mutation positive NSCLC in Singapore. A partitioned survival model with three health states (progression-free, progressive disease and death) was developed from a healthcare payer perspective. Survival curves from the LUX-Lung 3 trial (afatinib versus pemetrexed-cisplatin chemotherapy) were extrapolated beyond the trial period to estimate the underlying progression-free survival and overall survival parametric distributions. Rates of adverse reactions were also estimated from LUX-Lung 3 while health utilities from overseas were derived from the literature in the absence of local estimates. Direct costs were sourced from public healthcare institutions in Singapore. Incremental cost-effectiveness ratios (ICERs) were calculated over a 5 year time horizon. Deterministic and probabilistic sensitivity analyses and additional scenario analyses were conducted to explore the impact of uncertainties and assumptions on the cost-effectiveness results. In the base-case analysis, the ICER for afatinib versus pemetrexed-cisplatin was SG$137,648 per quality-adjusted life year (QALY) gained and SG$109,172 per life-year gained. One-way sensitivity analysis showed the ICER was most sensitive to variations in the utility values, the cost of afatinib and time horizon. Scenario analyses showed that even reducing the cost of afatinib by 50% led to a high ICER which was unlikely to represent a cost-effective use of healthcare resources. Compared with pemetrexed-cisplatin, afatinib is not cost-effective as a first-line treatment for advanced EGFR mutation-positive NSCLC in Singapore. The findings from our study will be useful to inform local healthcare decision-making and resource allocations for NSCLC treatments, together with other considerations such as clinical effectiveness, safety and affordability of TKIs. |
Mendeley readers
The data shown below were compiled from readership statistics for 83 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 83 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 10 | 12% |
| Student > Master | 9 | 11% |
| Student > Ph. D. Student | 8 | 10% |
| Student > Bachelor | 7 | 8% |
| Lecturer | 4 | 5% |
| Other | 11 | 13% |
| Unknown | 34 | 41% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 14 | 17% |
| Nursing and Health Professions | 8 | 10% |
| Pharmacology, Toxicology and Pharmaceutical Science | 7 | 8% |
| Biochemistry, Genetics and Molecular Biology | 4 | 5% |
| Business, Management and Accounting | 3 | 4% |
| Other | 12 | 14% |
| Unknown | 35 | 42% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 31 March 2018.
All research outputs
#20,472,403
of 23,031,582 outputs
Outputs from BMC Cancer
#6,536
of 8,365 outputs
Outputs of similar age
#291,396
of 330,033 outputs
Outputs of similar age from BMC Cancer
#189
of 234 outputs
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