THIRD LINE ERLOTINIB IN NSCLC MAY BE COST EFFECTIVE

NEW YORK (Reuters Health) Feb 17 - Erlotinib could be a cost-effective alternative to best supportive care as third-line treatment for advanced non-small-cell lung cancer (NSCLC), researchers from Canada report.

In clinical trials, erlotinib has provided an overall survival benefit compared with placebo as second- or third-line treatment for advanced NSCLC. But whether the drug is cost-effective compared to best supportive care has not been looked at, the researchers explain in their report, published online January 8 in Lung Cancer.

Ian Cromwell from Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, and colleagues studied the cost-effectiveness of third-line oral erlotinib (n=78) compared with a historical control group given best supportive care (n=69).

Median overall survival from the time of diagnosis of advanced NSCLC was significantly longer in the erlotinib group than in the control group (231 days vs. 138 days; p=0.004). Median progression to death was also longer in the erlotinib group than in the best supportive care group (114 days vs. 68 days; p<0.001).

The survival benefit of erlotinib treatment persisted after controlling for age, diagnosis date, smoking status, and histology.

Costs associated with erlotinib treatment averaged $34,326, compared with $23,224 for best supportive care. Most of the $11,102 added cost came from the cost of erlotinib.

Based on these figures, the annual incremental cost-effectiveness ratio (ICER) for erlotinib versus best supportive care was $36,838 per mean life year gained. But the wide 95% confidence intervals for the various outcomes and costs mean that ICER could go as high as $3,260,943 per life year gained.

Monte-Carlo analysis suggested that receiving third-line erlotinib is preferable to receiving best supportive care, both in terms of consistently added survival and acceptable (or reduced) incremental cost.

The authors caution that the results may not apply elsewhere.

"Costs from this study cannot be readily extrapolated to the systems of other countries -- costs from the Canadian health care are not reflective of costs in, for example, the United States," they write. "Differences in reimbursement of health professionals, capital and drug purchase costs, and the role of private insurers all affect the overall cost of health care, and differ across national and regional lines."

For Canada, though, "Our analysis suggests that erlotinib as third-line management of late-stage NSCLC may be cost-effective in many patients."