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Silvia Guzmán
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P2.14 - Targeted Therapy (ID 183)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Targeted Therapy
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.14-43 - Cost-Effectiveness of 1st-Line Treatment EGFR-TKIs for Advanced NSCLC Patients Harboring EGFR Mutation in Mexico (Now Available) (ID 1146)
10:15 - 18:15 | Author(s): Silvia Guzmán
- Abstract
Background
As cancer care costs are rising at an unprecedented rate, it is crucial to provide evidence-based justification for promising but expensive therapeutic approaches such as Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs). EGFR-TKIs such as gefitinib, erlotinib and afatinib had become the standard first-line treatment for EGFR gene mutation-positive non-small cell lung cancer (NSCLC) improving progression-free survival (PFS) and overall survival (OS) of these patients. However, the economic impact of them remain unclear. Hence, we aimed to assess healthcare costs during and after progression to treatment and to compare the cost-effectivess and safety of the 1st-line treatment with EGFR-TKIs in patients with advanced non-small cell lung cancer (NSCLC) in Mexico.
Method
The health and economic outcomes of three first-line strategies (gefitinib, erlotinib, and afatinib) among NSCLC patients harboring EGFRmutations were estimated and assessed. Costs in the Mexican setting were obtained from local hospital data and public national purchasing sources. The structure used in this analysis was a Markov model with three possible health states: free of progression, progression and death considering a time horizon of 3 and 5 years. The probabilities of transition and the use of resources used to feed the model were retrospectively collected by reviewing medical records of patients who were treated at the Instituto Nacional de Cancerologia (INCan) of Mexico between April 2013 and June 2017. Probabilistic sensitivity analysis (PSA) was conducted with a Monte Carlo simulation.
Result
Similar hazards of progression and death were obtained when constrasting afatinib vs. erlotinib, [HR:0.91 (95% CI: 0.59 -2.07) and 0.82 (95% CI: 0.56-2.65), respectively] as well as when contrasting the hazards of progression and death of afatinib vs. gefininib [HR:0.87 (95% CI: 0.87-1.53) and 0.94 (95% CI: 0.74-1.55), respectively]. However, statistically significant differences were identified between the costs of the treatment both the total cost (p<.001) and the daily cost (p <0.001) of treatment. The most expensive treatment was with afatinib, followed by erlotinib and gefitinib. In addition, treatment with afatinib showed the highest cost associated with adverse events. PSA with Monte Carlo simulations showed robustness of estimations.
Conclusion
Although equivalent effectiveness and safety of the three arms of the study was found, substantial differences in treatment costs were observed. Nonetheless, we should highlight that patient selection is absolutely critical for cost-efectiveness analyses; as well as longer follow-up of existing data could substantially alter the conclusions of this analysis.
