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Published in: The European Journal of Health Economics 7/2016

01-09-2016 | Original Paper

Cost-effectiveness analysis of EGFR mutation testing in patients with non-small cell lung cancer (NSCLC) with gefitinib or carboplatin–paclitaxel

Authors: Oscar Arrieta, Pablo Anaya, Vicente Morales-Oyarvide, Laura Alejandra Ramírez-Tirado, Ana C. Polanco

Published in: The European Journal of Health Economics | Issue 7/2016

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Abstract

Objective

Assess the cost-effectiveness of an EGFR-mutation testing strategy for advanced NSCLC in first-line therapy with either gefitinib or carboplatin–paclitaxel in Mexican institutions.

Methods

Cost-effectiveness analysis using a discrete event simulation (DES) model to simulate two therapeutic strategies in patients with advanced NSCLC. Strategy one included patients tested for EGFR-mutation and therapy given accordingly. Strategy two included chemotherapy for all patients without testing. All results are presented in 2014 US dollars. The analysis was made with data from the Mexican frequency of EGFR-mutation. A univariate sensitivity analysis was conducted on EGFR prevalence. Progression-free survival (PFS) transition probabilities were estimated on data from the IPASS and simulated with a Weibull distribution, run with parallel trials to calculate a probabilistic sensitivity analysis.

Results

PFS of patients in the testing strategy was 6.76 months (95 % CI 6.10–7.44) vs 5.85 months (95 % CI 5.43–6.29) in the non-testing group. The one-way sensitivity analysis showed that PFS has a direct relationship with EGFR-mutation prevalence, while the ICER and testing cost have an inverse relationship with EGFR-mutation prevalence. The probabilistic sensitivity analysis showed that all iterations had incremental costs and incremental PFS for strategy 1 in comparison with strategy 2.

Conclusion

There is a direct relationship between the ICER and the cost of EGFR testing, with an inverse relationship with the prevalence of EGFR-mutation. When prevalence is >10 % ICER remains constant. This study could impact Mexican and Latin American health policies regarding mutation detection testing and treatment for advanced NSCLC.
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Metadata
Title
Cost-effectiveness analysis of EGFR mutation testing in patients with non-small cell lung cancer (NSCLC) with gefitinib or carboplatin–paclitaxel
Authors
Oscar Arrieta
Pablo Anaya
Vicente Morales-Oyarvide
Laura Alejandra Ramírez-Tirado
Ana C. Polanco
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
The European Journal of Health Economics / Issue 7/2016
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-015-0726-5

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