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
France. The ICERs for all tested scenarios fell in that
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
PharmacoEconomics & Outcomes News 12 Aug 2017 No. 7841173-5503/17/0784-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved