PharmacoEconomics & Outcomes News 784, p8 - 12 Aug 2017 Afatinib cost effective for EGFRm+ NSCLC in France First-line treatment with afatinib is cost effective in France for patients with advanced epidermal growth- factor receptor mutation-positive non-small-cell lung cancer (EGFRm+ NSCLC), according to a study published in the Journal of Thoracic Oncology. Tyrokinase inhibitors are approved as first-line therapies for advanced NSCLC with an EGFR gene mutation. The cost effectiveness of two of these agents, afatinib and gefitinib, was compared using a partitioned survival model designed with data from the LUX-Lung 7 trial, the first prospective, multicentre, international, randomised, head-to-head trial of afatinib and gefitinib as first-line treatment for advanced EGFRm+ NSCLC. Direct medial costs were assessed over a 10-year time horizon, with costs estimated using official price lists, published data, fee schedules and questionnaires. A 4% discount rate was applied to costs and benefits. Afatinib was associated with a gain of 0.249 life-years and 0.17 quality-adjusted life-years (QALYs), compared with gefitinib, for the intention-to-treat (ITT) population. Subgroup analyses of patients with EGFR exon-19 deletion (del19) and EGFR exon-21 L858R mutation (L858R) supported this, with gains of 0.257 and 0.247 life-years, respectively, and 0.171 and 0.174 QALYs, respectively, for afatinib versus gefitinib. Afatinib had incremental cost-effectiveness ratios (ICERs) of €45 211, €38 970 and €52 518 for the ITT population, del19 subgroup and L858R subgroup, respectively, compared with gefitinib. Sensitivity analyses demonstrated that afatinib had a 100% probability of being cost effective for patients with common EGFR mutations at a willingness-to-pay (WTP) threshold of €70 000 per QALY. The authors noted that although cost-effectiveness analyses are mandatory in France for innovative drugs, there is no official WTP threshold. They concluded that "the World Health Organization-recommended conventional benchmark is an acceptable ICER-value range of 1–3 gross national product per capita, which would mean 2015 values of €32,735–€98,205 in France. The ICERs for all tested scenarios fell in that range". Chouaid C, et al. Cost-Effectiveness Analysis of Afatinib versus Gefitinib for first line treatment of advanced EGFR-Mutated Advanced Non-Small-Cell Lung Cancers. Journal of Thoracic Oncology : 24 Jul 2017 803262860 1173-5503/17/0784-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved PharmacoEconomics & Outcomes News 12 Aug 2017 No. 784
PharmacoEconomics & Outcomes News – Springer Journals
Published: Aug 12, 2017
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