Cost-Effectiveness Analysis of Erlotinib Plus Bevacizumab As First-Line Therapy for Advanced EGFR Mutation-Positive Non-Squamous Non-Small Cell Lung Cancer in Japan

OBJECTIVES: Although erlotinib plus bevacizumab significantly prolonged progression-free survival compared to erlotinib monotherapy in Japanese patients with EGFR mutation-positive non-small cell lung cancer (NSCLC), its cost-effectiveness is not necessarily clear. This study aimed to evaluate the cost-effectiveness of erlotinib plus bevacizumab compared with erlotinib alone in Japanese patients with EGFR positive NSCLC.

METHODS: A partitioned survival analysis model was developed to predict costs and quality-adjusted life years (QALY). Direct medical costs were considered in terms of the Japanese healthcare system. Lifetime horizon and discount rate of 2% per year was applied. Overall survival and progression-free survival data were obtained from the long-term follow-up of JO25567 trial. Cost parameters were estimated using JMDC claims database. Utilities were obtained from published sources outside of Japan. The incremental cost-effectiveness ratio (ICER) of erlotinib plus bevacizumab compared to erlotinib were estimated. Sensitivity analysis (SA) was performed to assess parameter uncertainty.

RESULTS: The base case analysis resulted in an incremental cost of JPY24,780,902, an incremental QALY of 0.791, and the ICER of JPY31,326,419/QALY. Deterministic SA showed that the parameter which most affected the ICER was the utility of erlotinib + bevacizumab PD status, with ICER variation ranged from JPY26,542,547 to JPY38,213,860/QALY. Probabilistic SA estimated a 0% probability that erlotinib plus bevacizumab would be cost-effective when the ICER threshold was set at JPY15 million/QALY.

CONCLUSIONS: Applying the threshold of JPY15 million/QALY, erlotinib plus bevacizumab combination therapy was not cost-effective. Under the Japan's public health insurance system, erlotinib monotherapy is preferable in terms of value for money.