Cross-market cost-effectiveness analysis of erlotinib as first-line maintenance treatment for patients with stable non-small cell lung cancer

Alain Vergnenègre¹, Joshua A Ray², Christos Chouaid³, Francesco Grossi⁴, Helge G Bischoff⁵, David F Heigener⁶, Stefan Walzer^2
1Department of Pneumology, Hôpital du Cluzeau, Limoges, France; ²Global Health Economics and Strategic Pricing, F Hoffmann-La Roche Ltd, Basel, Switzerland; ³Respiratory Service, Hôpital Saint Antoine, Paris, France; ⁴Lung Cancer Unit, National Institute for Cancer Research, Genoa, Italy; ⁵Thoracic Oncology, Onkologie Thoraxklinik Heidelberg, Heidelberg, Germany; ⁶Department of Thoracic Oncology, Krankenhaus Großhansdorf, Großhansdorf, Germany

Background: Platinum-doublet, first-line treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC) is limited to 4–6 cycles. An alternative strategy used to prolong the duration of first-line treatment and extend survival in metastatic NSCLC is first-line maintenance therapy. Erlotinib was approved for first-line maintenance in a stable disease population following results from a randomized, controlled Phase III trial comparing erlotinib with best supportive care. We aimed to estimate the incremental cost-effectiveness of erlotinib 150 mg/day versus best supportive care when used as first-line maintenance therapy for patients with locally advanced or metastatic NSCLC and stable disease.
Methods: An economic decision model was developed using patient-level data for progression-free survival and overall survival from the SATURN (SequentiAl Tarceva in UnResectable NSCLC) study. An area under the curve model was developed; all patients entered the model in the progression-free survival health state and, after each month, moved to progression or death. A time horizon of 5 years was used. The model was conducted from the perspective of national health care payers in France, Germany, and Italy. Probabilistic sensitivity analyses were performed.
Results: Treatment with erlotinib in first-line maintenance resulted in a mean life expectancy of 1.39 years in all countries, compared with a mean 1.11 years with best supportive care, which represents 0.28 life-years (3.4 life-months) gained with erlotinib versus best supportive care. In the base-case analysis, the cost per life-year gained was €39,783, €46,931, and €27,885 in France, Germany, and Italy, respectively.
Conclusion: Erlotinib is a cost-effective treatment option when used as first-line maintenance therapy for locally advanced or metastatic NSCLC.

Keywords: non-small cell lung cancer, cost-effectiveness, first-line maintenance, erlotinib, lung cancer