Cost-effectiveness analysis of gefitinib versus chemotherapy protocols in the first line treatment of non small-cell EGFR positive lung cancer

Abstract

Introduction: Lung cancer has high incidence and mortality in Brazil. Most tumors are non small-cell (NSCLC) and 54% present with metastases at diagnosis. The aim of this study was to evaluate the cost-effectiveness of gefitinib versus chemotherapy protocols in the treatment of advanced NSCLC with EGFR mutation in the first line, from the perspective of Brazilian Private Healthcare System. Methods: A cost-effectiveness analysis was developed based on a Markov model to compare the use of gefitinib versus cisplatin/docetaxel, cisplatin/vinorelbine, cisplatin/gemcitabine or carboplatin/paclitaxel. The outcomes considered were: progression-free survival, overall survival and quality adjusted survival. Only direct medical costs were included in the analysis, in a time horizon of 5 years. Costs and outcomes were discounted. The results were presented as the incremental cost-effectiveness ratio per life year saved. Results: The meta-analysis evaluating the efficacy of gefitinib estimated a HR of 0.43 for PFS and 0.82 for OS. The total costs in the time horizon of five years associated to treatment with gefitinib, cisplatin/docetaxel, cisplatin/vinorelbine, cisplatin/gemcitabine and carboplatin/paclitaxel were R$140,824, R$155,091, R$137,382, R$143,373 and R$169,749, respectively. The average benefit for each alternative was 2.105 and 1.898 life years for gefitinib and chemotherapy, respectively. Conclusion: Gefitinib was found to be dominant when compared to cisplatin/docetaxel, cisplatin/gemcitabine and carboplatin/paclitaxel. The cost per life-year saved comparing gefitinib with cisplatin/vinorelbine was R$16,643, being cost-effective if one considers the threshold of one time the Brazilian GDP per capita.