Budget impact of erlotinib for maintenance therapy in advanced non-small cell lung cancer

Abstract

Objective:

Assess the budgetary impact of adding erlotinib for maintenance therapy (MTx) in advanced non-small cell lung cancer (NSCLC) from a US health plan perspective.

Methods:

A budget impact model was developed to analyze the costs (drug, administration, adverse events) associated with adding erlotinib MTx to a hypothetical 500,000 member US health plan. Treatment durations and dosing were derived from randomized controlled trials, FDA labeling, and National Comprehensive Cancer Network guidelines. Treatment patterns and assumptions were based on market research data, the SEER registry, and published literature. Cost data were obtained from Centers for Medicare and Medicaid Services payment rates and a drug pricing database. Sensitivity analyses were conducted to assess uncertainty.

Results:

Overall health plan expenditures increased by $0.010 per member per month (PMPM). The main driver of additional cost was the erlotinib drug cost (～$66,000) with the administration ($464) and side-effect ($47) costs being relatively modest. One-way sensitivity analyses showed that the results were most sensitive to the proportion of members receiving MTx; however, the PMPM did not exceed $0.013.

Conclusions:

The overall budget impact to a health plan of expanding the use of erlotinib from the 2nd/3rd-line advanced NSCLC setting to include the maintenance setting was relatively small. This was primarily due to the proportion of patients who would receive erlotinib MTx, the low cost of side-effects and minimal cost of drug administration. Additional research may be warranted to estimate the relative clinical and economic impacts of erlotinib MTx versus alternative MTx treatments.     

吉非替尼与厄洛替尼治疗非小细胞肺癌效果的间接比较

目的系统评价吉非替尼与厄洛替尼治疗非小细胞肺癌的临床效果.方法检索国内外公开发表的关于吉非替尼或厄洛替尼治疗非小细胞肺癌的中英文文献,采用Bucher法对纳入的研究进行间接比较.结果共纳入4项吉非替尼vs标准治疗和3项厄洛替尼vs标准治疗的文献进行间接比较.吉非替尼与厄洛替尼治疗非小细胞肺癌的反应率和疾病控制率的 RR 值分别为0.56（P=0.0536）、0.87（P=0.6745）,中位生存期和中位无发展生存期的 MD 值分别为-0.31（P=0.7718）、-3.93（P=0.1443）.结论尽管间接比较存在一定的局限性,但结果表明吉非替尼与厄洛替尼治疗非小细胞肺癌的效果无显著性差异.     

Targeted erlotinib for first-line treatment of advanced non-small cell lung cancer: a budget impact analysis

Objectives:

A recent phase III trial showed that patients with advanced non-small cell lung cancer (NSCLC) whose tumors harbor specific EGFR mutations significantly benefit from first-line treatment with erlotinib compared to chemotherapy. This study sought to estimate the budget impact if coverage for EGFR testing and erlotinib as first-line therapy were provided in a hypothetical 500,000-member managed care plan.

Methods:

The budget impact model was developed from a US health plan perspective to evaluate administration of the EGFR test and treatment with erlotinib for EGFR-positive patients, compared to non-targeted treatment with chemotherapy. The eligible patient population was estimated from age-stratified SEER incidence data. Clinical data were derived from key randomized controlled trials. Costs related to drug, administration, and adverse events were included. Sensitivity analyses were conducted to assess uncertainty.

Results:

In a plan of 500,000 members, it was estimated there would be 91 newly diagnosed advanced NSCLC patients annually; 11 are expected to be EGFR-positive. Based on the testing and treatment assumptions, it was estimated that 3 patients in Scenario 1 and 6 patients in Scenario 2 receive erlotinib. Overall health plan expenditures would increase by $0.013 per member per month (PMPM). This increase is largely attributable to erlotinib drug costs, in part due to lengthened progression-free survival and treatment periods experienced in erlotinib-treated patients. EGFR testing contributes slightly, whereas adverse event costs mitigate the budget impact. The budget impact did not exceed $0.019 PMPM in sensitivity analyses.

Conclusions:

Coverage for targeted first-line erlotinib therapy in NSCLC likely results in a small budget impact for US health plans. The estimated impact may vary by plan, or if second-line or maintenance therapy, dose changes/interruptions, or impact on patients’ quality-of-life were included.     

非小细胞肺癌靶向治疗药物的疗效及经济性研究综述

目的综述非小细胞肺癌靶向治疗药物的临床疗效及药物经济学评价结果。方法基于非小细胞肺癌的流行病学特征和治疗发展趋势,选取临床应用较多的靶向治疗药物,并检索国内外相关文献,对其治疗非小细胞肺癌的临床疗效和经济性进行综合分析。结果吉非替尼和厄洛替尼是目前针对非小细胞肺癌最受关注的靶向治疗药物。针对不同类型的患者,两者表现出不同的临床疗效,而较少的药物经济学研究显示了其经济性。结论吉非替尼和厄洛替尼的临床疗效和经济性在总体上优于其它治疗方案,但还需更深入的研究。