Erlotinib breathes new life into NSCLC treatments
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Erlotinib breathes new life into NSCLC treatments – Suzanne Sullivan – Several studies presented at the 9th Annual European Congress of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) [Copenhagen, Denmark; October 2006] indicate that erlotinib is a cost-effective second- or third-line strategy for the treatment of non-small-cell lung cancer (NSCLC). The studies, undertaken in several countries in Europe and Canada, compared erlotinib with docetaxel, pemetrexed, or best supportive care (BSC) in patients with advanced disease; erlotinib was often found to be dominant or cost saving. Furthermore, some of the studies were bases for submissions to decision-making bodies in these countries, bringing hope that erlotinib may be incorporated into guidelines for the treatment of this deadly disease. Lung cancer is the leading cause of cancer-related deaths in many countries, such as Canada and the UK, and NSCLC is the predominant diagnosis. However, this disease can be difficult to treat, with many patients not presenting until the advanced stage and therefore have a poor prognosis. Current recommendations for first-line treatment of NSCLC usually involve a platinum-based chemotherapy regimen, followed by docetaxel or pemetrexed as second-line therapy. Erlotinib is an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor which has proven efficacy in NSCLC, with superior efficacy to BSC. Moreover, it is the first effective oral treatment for the disease. However, to date, no economic evaluations have been undertaken to determine the cost effectiveness of this agent. In addition, there have been no studies directly comparing erlotinib with docetaxel or pemetrexed, making it difficult to establish which agent offers best value. Five studies presented at the ISPOR meeting evaluated the cost effectiveness of erlotinib as a second- or third-line treatment for NSCLC, comparing the agent with docetaxel, pemetrexed or best supportive care (BSC).
Given the nod in The Netherlands The first study was a cost-effectiveness analysis comparing erlotinib, docetaxel and BSC, and was undertaken to support the reimbursement proposal for erlotinib in The Netherlands as a second- or third-line treatment for NSCLC.1* Researchers used efficacy data from the international phase III BR.21 study, in which 731 patients who had failed at least one previous chemotherapy regimen were randomised to doubleblind treatment with oral erlotinib 150mg once daily (n = 488) or BSC. In addition, a retrospective medical chart review was performed to obtain resource use in patients receiving BSC (n = 72) or docetaxel (24). Data were incorporated into a Markov model with a time horizon extrapolated to 3 years. A discount rate of 4% was applied to costs and effects, and costs (2004 values) were calculated from a societal perspective.** Both erlotinib and docetaxel were associated with incremental gains in life-years at an increased cost, compared with BSC [see table 1]. Although there was no difference in efficacy between e
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