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J. Graham
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P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.01-042 - Cost-Effectiveness of Afatinib vs. Erlotinib in the 1st-Line Treatment of Metastatic NSCLC Patients with EGFR Exon 19 Deletion Mutations (ID 2816)
09:30 - 09:30 | Author(s): J. Graham
- Abstract
Background:
EGFR mutation-positive (EGFR M+) NSCLC is a specific lung cancer subtype characterized by presence of EGFR mutations and sensitivity to treatment with EGFR tyrosine kinase inhibitors (TKIs). Common activating mutations (Del19, L858R) account for ~90% of EGFR M+ NSCLC cases. Afatinib, an oral, irreversible ErbB family blocker, improved progression-free survival (PFS) versus standard platinum-based chemotherapy in 1st-line EGFR M+ NSCLC. Afatinib also significantly prolonged overall survival (OS) in the EGFR Del19 mutation subgroup. Erlotinib, a reversible EGFR TKI licensed in the US has also improved PFS in EGFR Del19 mutation subgroup, but not OS. The objective of this study was to assess the cost-effectiveness of afatinib versus erlotinib in the 1st-line treatment of patients with metastatic EGFR Del19 M+ NSCLC in the US healthcare setting.
Methods:
A partitioned survival model was developed consisting of “progression-free”, “progressive disease”, and “death” health states. Patients entered the model in the progression-free state and advanced to progressive disease and death based on the progression-free survival and overall survival curves. The survival curves for afatinib were estimated by fitting parametric models to the empirical data from the LUX-Lung 3 clinical trial. For erlotinib the survival curves were estimated based on hazard ratios that were applied to the afatinib curves. The hazard ratios were derived via a network meta-analysis. Patients incurred treatment-specific drug costs for afatinib and erlotinib until disease progression. Costs to treat grade 3/4 adverse events were applied to each treatment. Resource use from the LUX-Lung 3 trial data and unit costs from published literature and from standard U.S. sources were used to derive the additional, monthly costs of being progression free. Monthly continuing care costs and one-time, end-of-life costs for patients with progressive disease were obtained from published literature. The utility of progression-free disease was obtained from LUX-Lung 3, and the disutility of progressive disease was obtained from the published literature. Disutilities associated with adverse events were also obtained from the literature. The model calculated patient survival (life years) and quality of life adjusted years (QALYs), and total costs per patient. Incremental cost-effectiveness ratios (ICERs) were calculated as the ratio of the difference in cost to the difference in LYs and QALYs. Costs and outcomes were calculated over a 20-year time horizon and discounted at an annual rate of 3%.
Results:
Based on the model, the patients taking afatinib accrued more life years (3.09 vs. 2.46) and QALYs (2.17 vs. 1.72) than patients taking erlotinib. Although the wholesale acquisition cost (WAC) of afatinib was lower than that of erlotinib, the incremental per patient cost was higher with afatinib ($ 32,961) owing to patients spending more time in “progression-free”, and “post-progression” health states in the afatinib group. At an accepted US ICER threshold of $100,000/QALY, afatinib vs. erlotinib had an ICER/QALY gained of $74,345 and cost per LY gained was $52,401.
Conclusion:
Afatinib as a 1st-line therapy for locally advanced or metastatic NSCLC with EGFR exon 19 deletion mutations is a cost-effective alternative to erlotinib according to the commonly accepted cost-effectiveness threshold in the US.
