OBJECTIVES : The study was conducted to evaluate the cost-effectiveness of Dacomitinib versus other TKI comparators (gefitinib, erlotinib, icotinib, afatinib and osimertinib) for locally advanced or metastatic non-small cell lung cancer with EGFR-activating mutations from the social perspective of China.

METHODS : A three-state partitioned survival model was developed. Parametric survival analysis was conducted to extrapolate the data to a life-time horizon of 15 years. Hazard ratios (HR) of overall survival and progression-free survival were obtained from the phase III trial ARCHER 1050 and a network meta-analysis among Asian population. Treatment pathways were obtained through literature review and expert interviews. Direct cost as well as indirect cost were included in the analysis. Drug prices were obtained from national reimbursement drug list and listed drug list. Utilities were obtained from ARCHER 1050 which used EQ-5D-5L and quality-adjusted life year (QALY) was measured. A discount rate of 5% was used for both costs and utilities. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were conducted to measure the uncertainty.

RESULTS : For dacomitinib comparing to gefitinib, erlotinib, icotinib and afatinib, the ICURs were 153,458 RMB, 111,978 RMB, 104,307 RMB and 23,006 RMB per QALY respectively. ICURs of gefitinib and erlotinib were higher and which of icotinib and afatinib were lower than the 106,819 RMB WTP threshold (1.5 times of 2019 Chinese GDP per capita). Osimertinib was dominated by dacomitinib. The incremental cost per life year (LY) were 108,320 RMB, 112,331 RMB, 50,428 RMB and 15,617 RMB respectively. DSA showed that HRs and the cost of dacomitinib were the main drivers to the outcomes. The tendency showed by PSA was consistent with the outcomes of base case analyses.

CONCLUSIONS : Under the 106,819 RMB WTP threshold, dacomitinib was not cost-effective compared to gefitinib and erlotinib; was cost-effective compared to icotinib and afatinib; and was cost-saving compared to osimertinib.