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Open Access Research article

Gene-guided Gefitinib switch maintenance therapy for patients with advanced EGFR mutation-positive Non-small cell lung cancer: an economic analysis

Jun Zhu1, Te Li1, Xiaohui Wang2, Ming Ye3, Jian Cai4, Yuejuan Xu5 and Bin Wu6*

Author affiliations

1 Department of Pharmacy, Shanghai Chest Hospital, affiliated with the School of Medicine, Shanghai Jiaotong University, West Huaihai Road 241, Shanghai, China

2 Department of Pharmacy, Yuxi People’s Hospital, affiliated with the Kunming Medical College, Nieer Road 21, Yuxi, China

3 Department of Clinical Oncology, Renji Hospital, affiliated with the School of Medicine, Shanghai Jiaotong University, Dongfang Road 1630, Shanghai, China

4 Department of Clinical Oncology, Taixing People’s Hospital, affiliated with the School of Medicine, Yangzhou University, Changzheng Road 1, Taixing, China

5 Department of Clinical Oncology, the Second Hospital of Nanjing, affiliated with the Medical School of South East University, Zhongfu Road 1, Nanjing, China

6 Medical Decision and Economic Group, Department of Pharmacy, Renji Hospital, affiliated with the School of Medicine, Shanghai Jiaotong University, Dongfang Road 1630, Shanghai, China

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Citation and License

BMC Cancer 2013, 13:39  doi:10.1186/1471-2407-13-39

Published: 29 January 2013

Abstract

Background

Maintenance therapy with gefitinib notably improves survival in patients with advanced non-small cell lung cancer (NSCLC) and EGFR mutation-positive tumors, but the economic impact of this practice is unclear.

Methods

A decision-analytic model was developed to simulate 21-day patient transitions in a 10-year time horizon. The clinical data were primarily obtained from the results of a pivotal phase III trial that assessed gefitinib maintenance treatment in patients with advanced NSCLC. The cost data were derived from the perspective of the Chinese health care system. The primary outcome was the incremental cost-effectiveness ratio (ICER) at a willingness-to-pay (WTP) threshold of 3 times the per capita GDP of China. Sensitivity analyses were used to explore the impact of uncertainty regarding the results. The impact of the gefitinib patient assistance program (GPAP) was evaluated.

Results

After EGFR genotyping, gefitinib maintenance treatment for advanced NSCLC with EGFR mutations increased the life expectancy by 0.74 years and 0.46 QALYs compared with routine follow-up at an additional cost of $26,149.90 USD ($7,178.20 with the GPAP). The ICER for gefitinib maintenance was $57,066.40 and $15,664.80 per QALY gained (at a 3% discount rate) without and with the GPAP, respectively. The utility of progression free survival, the hazard ratio of progression-free survival for gefitinib treatment and the cost of gefitinib per dose were the three factors that had the greatest influence on the results.

Conclusions

These results indicate that gene-guided maintenance therapy with gefitinib with the GPAP might be a cost-effective treatment option.

Keywords:
Gefitinib maintenance treatment; EGFR mutation; Cost-effectiveness; Non-small cell lung cancer