A Cost-Utility Analysis of Dacomitinib As First-Line Treatment for Patients with Locally Advanced or Metastatic Non-Small Cell Lung Cancer with EGFR Exon 21 L858R Substitution Mutation in China
Author(s)
Jin G1, Zhao J2, Luan L3, Dong P3, Yang L2
1Peking University, London, UK, 2Peking University, Beijing, 11, China, 3Pfizer Investment Co., Ltd., Beijing, 11, China
OBJECTIVES：Dacomitinib is a human epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI). 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 exon 21 L858R substitution mutation from the social perspective in China. METHODS：A three-state partitioned survival model was developed with a 15-year horizon. Hazard ratios (HR) of overall survival and progression-free survival were obtained from the phase III trial ARCHER 1050 and a network meta-analysis. Direct cost as well as indirect cost were considered. Drug prices were obtained from national reimbursement drug list and listed drug list. In addition, gefitinib used centralized procurement price; the prices of dacomitinib and icotinib were reduced based on Patient Assistance Programs (PAP). Utilities were obtained from ARCHER 1050 which used EQ-5D-5L and quality-adjusted life year (QALY) was measured. The discount rate was 5%. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were conducted. RESULTS：For dacomitinib comparing to gefitinib, erlotinib, icotinib and afatinib, the ICURs were 208,853, 187,209, 78,863 and 100,455 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 117,452, 138,262, 17,504 and 57,329 RMB respectively. CONCLUSIONS：Under the 106,819 RMB WTP threshold, dacomitinib was not cost-effective compared to gefitinib and erlotinib and; was cost-effective compared to icotinib and afatinib; and was cost-saving compared to osimertinib.
Conference/Value in Health Info
2021-05, ISPOR 2021, Montreal, Canada
Value in Health, Volume 24, Issue 5, S1 (May 2021)
Code
PRS15
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Respiratory-Related Disorders