Economic Outcomes of Maintenance Gefitinib for Locally Advanced-Metastatic Non-Small-Cell Lung Cancer with Unknown EGFR Mutations: A Semi-Markov Model AnalysisReportar como inadecuado




Economic Outcomes of Maintenance Gefitinib for Locally Advanced-Metastatic Non-Small-Cell Lung Cancer with Unknown EGFR Mutations: A Semi-Markov Model Analysis - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Background

Maintenance gefitinib significantly prolonged progression-free survival PFS compared with placebo in patients from eastern Asian with locally advanced-metastatic non-small-cell lung cancer NSCLC after four chemotherapeutic cycles 21 days per cycle of first-line platinum-based combination chemotherapy without disease progression. The objective of the current study was to evaluate the cost-effectiveness of maintenance gefitinib therapy after four chemotherapeutic cycle’s stand first-line platinum-based chemotherapy for patients with locally advanced or metastatic NSCLC with unknown EGFR mutations, from a Chinese health care system perspective.

Methods and Findings

A semi-Markov model was designed to evaluate cost-effectiveness of the maintenance gefitinib treatment. Two-parametric Weibull and Log-logistic distribution were fitted to PFS and overall survival curves independently. One-way and probabilistic sensitivity analyses were conducted to assess the stability of the model designed. The model base-case analysis suggested that maintenance gefitinib would increase benefits in a 1, 3, 6 or 10-year time horizon, with incremental $184,829, $19,214, $19,328, and $21,308 per quality-adjusted life-year QALY gained, respectively. The most sensitive influential variable in the cost-effectiveness analysis was utility of PFS plus rash, followed by utility of PFS plus diarrhoea, utility of progressed disease, price of gefitinib, cost of follow-up treatment in progressed survival state, and utility of PFS on oral therapy. The price of gefitinib is the most significant parameter that could reduce the incremental cost per QALY. Probabilistic sensitivity analysis indicated that the cost-effective probability of maintenance gefitinib was zero under the willingness-to-pay WTP threshold of $16,349 3×per-capita gross domestic product of China. The sensitivity analyses all suggested that the model was robust.

Conclusions

Maintenance gefitinib following first-line platinum-based chemotherapy for patients with locally advanced-metastatic NSCLC with unknown EGFR mutations is not cost-effective. Decreasing the price of gefitinib may be a preferential choice for meeting widely treatment demands in China.



Autor: Xiaohui Zeng, Jianhe Li, Liubao Peng , Yunhua Wang, Chongqing Tan, Gannong Chen, Xiaomin Wan, Qiong Lu, Lidan Yi

Fuente: http://plos.srce.hr/



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