To assess the cost-effectiveness of afatinib compared to erlotinib for the treatment of squamous NSCLC after first-line platinum based therapy from the French healthcare funders perspective.

A partitioned survival model was developed containing three health states: pre-progression, post-progression and death. Results from the LUX-Lung 8 trial which compared afatinib with erlotinib in patients with squamous NSCLC were used. Life expectancy, quality-adjusted life expectancy and direct costs were evaluated over a 10-year time horizon. Future costs and clinical benefits were discounted at 4% annually.

Deterministic and probabilistic sensitivity analyses were performed.

From the French healthcare funders perspective, patients receiving afatinib for squamous NSCLC after first-line platinum benefitted from longer life expectancy than those treated with erlotinib, (0.94 years versus 0.78 years respectively) translating in an increase of 0.16 years. Quality adjusted life expectancy was also projected to be greater in patients treated with afatinib with an increase of 0.094 QALYs (0.567 QALYs versus 0.473 QALYs) for afatinib and erlotinib respectively. The total cost of treatment over a 10-year time horizon was higher for afatinib than erlotinib, EUR 12,364 versus EUR 9,510, leading to an incremental cost-effectiveness ratio of EUR 30,277 per QALY gained for afatinib versus erlotinib.

Sensitivity analyses showed the robustness of the cost-effectiveness analysis. The base case findings remained stable under variation in a range of model inputs.

Based on data from the LUX-Lung 8 trial, afatinib was projected to improve clinical outcomes versus erlotinib, with an 89% probability of being cost-effective assuming a willingness to pay of EUR 50,000 per QALY gained, following a first-line platinum based therapy for patients with squamous NSCLC in France.