Abstract
Cost-effectiveness of afatinib versus erlotinib for the treatment of squamous non-small cell lung cancer in france after a first-line platinum based therapy
Non-small cell lung cancer (NSCLC) accounts for 85% of all lung cancers and has an extremely poor prognosis. Afatinib, an irreversible ErbB family blocker, is approved in Europe for squamous NSCLC after a first-line platinum based therapy. The objective was to evaluate the cost-effectiveness of afatinib versus erlotinib in this setting in France.
The study population was taken from the LUX-Lung 8 trial which compared afatinib with erlotinib in patients with squamous NSCLC. A Markov model was used to evaluate cost-effectiveness based on progression-free survival and overall survival in the trial. Life expectancy, quality-adjusted life expectancy and direct costs were evaluated over a 10-year time horizon. Deterministic and probabilistic sensitivity analyses were performed.
Model projections indicated that patients-treated with afatinib benefitted from longer life expectancy than those treated with erlotinib (0.94 years versus 0.78 years respectively) translating to an increase of 0.094 quality-adjusted life years (QALYs). 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 small variations in results.
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, after a first-line platinum based therapy for patients with squamous NSCLC in France.