A systematic review of the cost-effectiveness of targeted therapies for metastatic non-small cell lung cancer (NSCLC)
Open accessAbstract
BACKGROUND: Non-small cell lung cancer (NSCLC) imposes a substantial burden on patients, health care systems and society due to increasing incidence and poor survival rates. In recent years, advances in the treatment of metastatic NSCLC have resulted from the introduction of targeted therapies. However, the application of these new agents increases treatment costs considerably. The objective of this article is to review the economic evidence of targeted therapies in metastatic NSCLC. METHODS: A systematic literature review was conducted to identify cost-effectiveness (CE) as well as cost-utility studies. Medline, Embase, SciSearch, Cochrane, and 9 other databases were searched from 2000 through April 2013 (including update) for full-text publications. The quality of the studies was assessed via the validated Quality of Health Economic Studies (QHES) instrument. RESULTS: Nineteen studies (including update) involving the MoAb bevacizumab and the Tyrosine-kinase inhibitors erlotinib and gefitinib met all inclusion criteria. The majority of studies analyzed the CE of first-line maintenance and second-line treatment with erlotinib. Five studies dealt with bevacizumab in first-line regimes. Gefitinib and pharmacogenomic profiling were each covered by only two studies. Furthermore, the available evidence was of only fair quality. CONCLUSION: First-line maintenance treatment with erlotinib compared to Best Supportive Care (BSC) can be considered cost-effective. In comparison to docetaxel, erlotinib is likely to be cost-effective in subsequent treatment regimens as well. The insights for bevacizumab are miscellaneous. There are findings that gefitinib is cost-effective in first- and second-line treatment, however, based on only two studies. The role of pharmacogenomic testing needs to be evaluated. Therefore, future research should improve the available evidence and consider pharmacogenomic profiling as specified by the European Medicines Agency. Upcoming agents like crizotinib and afatinib need to be analyzed as well.
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In EGFRm+ NSCLC, EGFR TKIs have a clear benefit over platinum-based chemotherapy in terms of cost-effectiveness.
“In EGFRm+ NSCLC, EGFR TKIs have a clear benefit over platinum-based chemotherapy in terms of cost-effectiveness.”
From Afatinib for the treatment of <i>EGFR</i> mutation-positive NSCLC: A review of clinical findings (2020) · cites this paper as [111]
The Results section (page not provided) reports one study finding first-line erlotinib cost-effective versus carboplatin–gemcitabine in EGFR mutation-positive NSCLC, from a Chinese health-care perspective. The Discussion cautions that this study’s results have limited reliability, so it does not establish a clear benefit for EGFR TKIs generally over platinum-based chemotherapy. (LLM, conf=0.88)
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- Authors
- Lange, A., Prenzler, A., Frank, M., Golpon, H., Welte, T., & von der Schulenburg, J.-M.
- Affiliations
- Leibniz University Hannover (DE)
- Medizinische Hochschule Hannover (DE)
- Corresponding author
- Lange, Ansgar
- Venue
- BMC Pulmonary Medicine
- Published
- 2014-12
- Volume
- 14
- Issue
- 1
- Pages
- 192-192
- ISSN
- 1471-2466 (ISSN-L)
- PMC
- PMC4269853
- OpenAlex
- W2007734670
- Cited by
- 38
- References
- 34
- Citations by year
- 2026: 1 · 2024: 2 · 2022: 3 · 2021: 5 · 2020: 5 · 2019: 5 · 2018: 5 · 2017: 4 · 2016: 4 · 2015: 4
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Pulmonary Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Institutional Repository of Leibniz Universität Hannover (Leibniz Universität Hannover) (submittedVersion, cc-by-nc-nd)
- Institutional Repository of Leibniz Universität Hannover (Leibniz Universität Hannover) (submittedVersion, cc-by)
- Leibniz Universität Hannover (cc-by)
- Funders
- Bundesministerium für Bildung und Forschung
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Keywords
- metastatic non-small cell lung cancer, targeted therapy, cost-effectiveness, cost-utility analysis, erlotinib, gefitinib, bevacizumab, tyrosine kinase inhibitors, first-line maintenance therapy, docetaxel, best supportive care
- MeSH terms
- Bevacizumab, Erlotinib Hydrochloride, Gefitinib, Antibodies, Monoclonal, Antineoplastic Combined Chemotherapy Protocols, Carcinoma, Non-Small-Cell Lung, Cost-Benefit Analysis, Humans, Lung Neoplasms, Quinazolines, Protein Kinase Inhibitors, Molecular Targeted Therapy
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