A systematic review of the cost-effectiveness of targeted therapies for metastatic non-small cell lung cancer (NSCLC)
Creators: name: Lange, Ansgar
name: Prenzler, Anne
name: Frank, Martin
name: Golpon, Heiko
name: Welte, Tobias
name: Schulenburg, Johann-Matthias Graf Von Der
Publisher: name: London : BioMed Central Ltd.
Year: 2014
Subjects: subject: Afatinib
subject: Bevacizumab
subject: Cost-effectiveness analysis
subject: Cost-utility analysis
subject: Crizotinib
subject: Erlotinib
subject: Gefitinib
subject: Health economics
subject: Monoclonal antibody
subject: Non-small cell lung cancer
subject: Targeted therapy
subject: Tyrosine kinase inhibitors
subject: afatinib
subject: antineoplastic agent
subject: bevacizumab
subject: cetuximab
subject: crizotinib
subject: docetaxel
subject: erlotinib
subject: gefitinib
subject: pemetrexed
subject: advanced cancer
subject: Article
subject: cancer chemotherapy
subject: cancer combination chemotherapy
subject: cancer staging
subject: cost effectiveness analysis
subject: cost utility analysis
subject: data base
subject: drug cost
subject: drug efficacy
subject: economic aspect
subject: Embase
subject: follow up
subject: human
subject: Medline
subject: metastasis
subject: non small cell lung cancer
subject: overall survival
subject: patient care
subject: pharmacogenomics
subject: quality of health economic study questionnaire
subject: questionnaire
subject: SciSearch
subject: systematic review
subject: Dewey Decimal Classification::600 | Technik::610 | Medizin, Gesundheit

description: 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.