ABSTRACT

Objective

To estimate the cost-effectiveness of sequences starting with tyrosine kinase inhibitors (TKI), afatinib and osimertinib, for the treatment of epidermal growth factor receptor (EGFR) mutation-positive (Exon 19 deletion or L858R) non-small cell lung cancer (NSCLC), stages IIIB – IV in Colombia.

Methods

A partitioned survival model was designed, using information from global and progression-free survival curves. For first and second-generation TKI, second line treatment was assumed according to the presence of T790M mutation to define the use of osimertinib or chemotherapy. The cost of the states without progression and post-progression was estimated using the base case approach, identified through consultation with clinical experts.

Results

The cost of treatment starting with afatinib in the first line was of 222,247 USD (1 USD = 3171.99 COP) and produced 1.36 QALYs. The strategy with afatinib was dominant with respect to that of first line TKI (227,289 USD and 1.34 QALY). The strategy with osimertinib resulted in more QALYs and higher costs, with ICERs of 35,062 USD, exceeding the current willingness to pay threshold for Colombia.

Conclusions

Treatment starting with afatinib in the first line is dominant with respect to the strategy with first line TKI. The ICER of osimertinib sequence exceeds the threshold when compared with afatinib one.

中文翻译：

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哥伦比亚表皮生长因子受体突变晚期非小细胞肺癌中酪氨酸激酶抑制剂的增量成本效益分析

摘要

客观的

评估从酪氨酸激酶抑制剂 (TKI)、阿法替尼和奥希替尼开始的序列治疗表皮生长因子受体 (EGFR) 突变阳性（外显子 19 缺失或 L858R）非小细胞肺癌 (NSCLC) 的成本效益)，哥伦比亚的 IIIB - IV 阶段。

方法

使用来自全局和无进展生存曲线的信息设计了一个分区生存模型。对于第一代和第二代 TKI，根据 T790M 突变的存在假设二线治疗来定义奥希替尼或化疗的使用。没有进展和进展后的状态的成本是使用基本案例方法估计的，通过咨询临床专家确定。

结果

从一线阿法替尼开始的治疗费用为 222,247 美元（1 美元 = 3171.99 COP），产生了 1.36 个 QALY。阿法替尼策略在一线 TKI 策略（227,289 美元和 1.34 QALY）方面占主导地位。使用奥希替尼的策略导致更多的 QALY 和更高的成本，ICER 为 35,062 美元，超过了哥伦比亚目前的支付意愿门槛。

结论

就一线 TKI 策略而言，一线治疗以阿法替尼为主导。与阿法替尼相比，奥希替尼序列的 ICER 超过阈值。