OBJECTIVES: Tyrosine kinase inhibitors of the epidermal growth factor receptor (EGFR) are the standard treatments for Chinese patients with advanced non-small cell lung cancer (NSCLC) harboring an EGFR mutation, but their economic impact is unclear yet in China.

METHODS: A decision-analytic model was developed to simulate 1-month patient transitions in a 10-year time horizon from Chinese healthcare system’s perspective. The health and economic outcomes of four first-line strategies (pemetrexed plus cisplatin [PC], gefitinib, erlotinib, and afatinib) among NSCLC patients harboring EGFR mutations were estimated. The clinical parameters including survival and safety data were derived from afatinib LUX-Lung trials or indirect comparison. Utilities from LUX-Lung and LUCEOR studies were used in the model. The costs were estimated through local hospital data and literature review. The patient assistance program (PAP) in China was considered. The PAP schemes of afatinib, gefitinib, and erlotinib were “buy 7, 8, and 4 months and get the rest for free,” respectively. A 5% annual discount rate was applied to both costs and outcomes. The primary outcome was the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed.

RESULTS: Afatinib achieved additional 0.38, 0.22, and 0.17 quality-adjusted life-years (QALYs) with marginal costs of ¥20,545, ¥31,760, and ¥−10,917 with the PAP, which resulted in ICERs of ¥53,834, ¥147,059 and ¥−62,812 (afatinib dominates) per QALY gained, compared to PC, gefitinib, and erlotinib, respectively. These results indicated that afatinib is cost-effective at a willingness-to-pay threshold ¥161,940/QALY in China. The price of pemetrexed, the EGFR mutation prevalence, and the utility of progression-free survival were those factors that had considerable impacts on the model outcomes.

CONCLUSIONS: These results indicated that EGFR TKI, afatinib, might be a cost-effective treatment option than traditional chemotherapy and other EGFR-TKIs in China.