identify those suitable for platinum-based doublet chemotherapy, and therefore do not need to be considered. Table 6: List of resources to be considered in the economic analysis Provider of resource Setting in which resource is provided Proportion of patients receiving resource Number of units of resource per relevant time horizon per patient receiving resource Disaggregated unit cost MBS Safety nets* Other govt budget Private health insurer Patient Total cost Resources provided in association with the proposed medical service to deliver the proposed intervention (from Step 1, e.g., co-administered interventions). Identify variations where these may vary across different decision options Test and intervention: EGFR testing and first line afatinib treatment for patients who are EGFR mutation positive and first line platinum doublet chemotherapy for patients who are EGFR mutation wild type EGFR testing costs Re-biopsy (if inadequate tumour sample) Respiratory physician or surgeon Hospital 1 unit of patients eligible for EGFR testing) Estimate Specimen collection including Patient Episode Initiation (PEI) fee MBS Collection centre To be provided in submission To be provided in submission Specimen referred fee (P11) MBS Pathology Lab To be provided in submission To be provided in submission 10.30 Perform EGFR testing Molecular pathologist Laboratory 1 unit (100% of patients eligible for EGFR testing) Proposed frequency of testing 300.00 (75%) 340.00 (85%) 400.00 If EGFR mutation positive, patient is eligible for first line treatment with afatinib Consultation for initiation of afatinib (oral tablet) Medical oncologist Private rooms or inpatient/ outpatient clinic 1 unit/EGFR mutation positive patient data for proportion of first line patients EGFR mutation positive Estimate from Lux Lung 3 trial Cost of afatinib (PBS cost ) Proposed PBS item Community pharmacy 1 mutation positive patient Weighted cost per dose and for duration of treatment from Lux Lung 3 trial Follow up consultation monitoring disease and treatment (MBS item) Medical oncologist Private rooms or inpatient/ outpatient clinic 1 unit/2 mutation positive patient Estimate from Lux Lung 3 trial If EGFR wild type, patient is eligible for first line treatment with platinum doublet chemotherapy Consultation for initiation of chemotherapy (MBS Medical oncologist Private rooms or 1 unit / EGFR WT data for 72.65 R
116) clinic patient/cycle proportion of first line patients EGFR WT estimated from Lux Lung 3 trial Cost of chemotherapy (1 x 45mg carboplatin) (PBS cost per maximum quantity) PBS item day treatment facility, private or public hospital outpatient clinic 1 unit / EGFR WT patient / cycle Estimate number of cycles form Lux Lung 3 trial 265.32 Cost of chemotherapy (1 x 3000mg gemcitabine) (PBS cost per maximum quantity) PBS item day treatment facility, private or public hospital outpatient clinic 1 unit / EGFR WT patient / cycle Estimate number of cycles form Lux Lung 3 trial Drug administration cost for <1 hour infusion (MBS item 13915) Day patient Once every 3 weeks. No. of infusions per patient TBD $62.60 Public hospital outpatient admission for administration Out-patient ~86% (EGFR negative pts) Once every 3 weeks. No. of infusions per patient TBD $560.00 Full day hospital admission for chemotherapy administration in a public hospital setting (excluding average pharmacy component) Day patient ~86% (EGFR negative pts) Once every 3 weeks. No. of infusions per patient TBD $562.00 Full day hospital admission for chemotherapy administration in a private hospital setting Day patient ~86% (EGFR negative pts) Once every 3 weeks. No. of infusions per patient TBD $331.00 Follow up consultation monitoring disease and treatment (MBS item) Medical oncologist Private rooms or inpatient/ outpatient clinic 1 unit/2 mutation positive patient Estimate from Lux Lung 3 trial Resources provided in association with proposed intervention Management of side effects of afatinib Management of side effects of chemotherapy Resources provided to deliver the comparator to the current intervention (from Step 4, e.g., pre-treatments, co-administered interventions). Identify variations where there may be more than one comparator or where these may vary across different decision R
options Main comparator: no EGFR testing and first line platinum doublet chemotherapy for all patients Consultation for initiation of chemotherapy (MBS 116) Medical oncologist Private rooms or clinic 1 unit / EGFR WT patient/cycle data for proportion of first line patients EGFR WT estimated from Lux Lung 3 trial 72.65 Cost of chemotherapy (1 x 45mg carboplatin) (PBS cost per maximum quantity PBS item day treatment facility, private or public hospital outpatient clinic 1 unit / EGFR WT patient / cycle Estimate number of cycles form Lux Lung 3 trial Cost of chemotherapy (1 x 3000mg gemcitabine) (PBS cost per maximum quantity) PBS item day treatment facility, private or public hospital outpatient clinic 1 unit / EGFR WT patient / cycle Estimate number of cycles form Lux Lung 3 trial Drug administration cost for <1 hour infusion (MBS item 13915) Day patient 100% Once every 3 weeks. No. of infusions per patient TBD $62.60 Public hospital outpatient admission for administration Out-patient 100% Once every 3 weeks. No. of infusions per patient TBD $560.00 Full day hospital admission for chemotherapy administration in a public hospital setting (excluding average pharmacy component) Day patient 100% Once every 3 weeks. No. of infusions per patient TBD $562.00 Full day hospital admission for chemotherapy administration in a private hospital setting Day patient 100% Once every 3 weeks. No. of infusions per patient TBD $331.00 Follow up consultation monitoring disease and treatment MBS item Medical oncologist Private rooms or inpatient/ outpatient clinic 1 unit/2 months/all patients Estimate from Lux/Lung 3 trial Resources provided in association with the comparator: platinum-based doublet chemotherapy