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. 2022 Jan 31:9:22-29.
doi: 10.33393/grhta.2022.2351. eCollection 2022 Jan-Dec.

Budget Impact di afatinib per il trattamento in prima linea del Non Small Cell Lung Cancer (NSCLC) con mutazioni non comuni EGFR

[Article in Italian]
Giuseppe Pompilio  1 , Alessandro Morabito  2 , Diego L Cortinovis  3 , Davide Integlia  1
Affiliations

Budget Impact di afatinib per il trattamento in prima linea del Non Small Cell Lung Cancer (NSCLC) con mutazioni non comuni EGFR

[Article in Italian]
Giuseppe Pompilio et al. Glob Reg Health Technol Assess. .

Abstract

Background:: The current clinical practice for patients affected by Non-Small Cell Lung Cancer (NSCLC) with uncommon mutation is based on afatinib and osimertinib, second and third generation of Tyrosine Kinase Inhibitor (TKI) respectively. For uncommon EGFR mutations, it is still unclear which EGFR TKI is most effective, since there are few dedicated prospective studies and Next Generation Sequencing (NGS) techniques trace an increasingly large and sometimes little-known population of EGFR mutations.

Objective:: To determine the economic impact associated to afatinib and osimertinib, a Budget Impact model considering a 3-year time horizon with two scenarios was developed: a first scenario, called AS IS, based on treatment with afatinib and osimertinib according to a distribution of market shares as emerged from clinical practice; a second suitable scenario, called TO BE, based on reviewed literature data, assuming for each year a 10%, 15% and 20% increase in afatinib use, respectively.

Methods:: Budget Impact analysis was conducted using a dynamic cohort model, in which the annual number of patients with NSCLC and uncommon mutations was equally distributed over 12 months. Progression-free survival (PFS) data for afatinib and osimertinib were extrapolated up to 36 months from published Kaplan Meier curves, and then the number of patients was estimated for each treatment.

Results:: The increase of 10% in afatinib use allowed a saving of drug acquisition costs for the Italian NHS, over the 3-year time horizon, of –€ 622,432. The univariate sensitivity analysis shows the market share of osimertinib to be the parameter significantly affecting the results achieved in the base case.

Conclusions:: The potential increase in the use of afatinib in patients with NSCLC and uncommon mutations leads to lower drug acquisition costs, lower Budget Impact and a saving of money for the Italian NHS.

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Conflict of interest statement

Conflict of interest: GP and AM declare no conflict of interest. DLC reports Speaker Bureau and Scientific Advisor for Roche, Astra Zeneca, Amgen, Novartis, BMS, MSD, and Boehringer Ingelheim. DI is the CEO of ISHEO srl and has received grants from Abbvie, Merck Serono, Bristol Myers Squibb, Pierre Fabre, Eli Lylli, Boehringer Ingelheim, Angelini, Fidia Pharma, and AlfaSigma.

Figures

Fig. 1 -
Fig. 1 -
Adattamento distribuzioni statistiche curva PFS ricostruita afatinib.
Fig. 2 -
Fig. 2 -
Adattamento distribuzioni statistiche curva PFS ricostruita osimertinib.
Fig. 3 -
Fig. 3 -
Analisi di sensibilità univariata.
Fig. 4 -
Fig. 4 -
Analisi di scenario condotta facendo variare, per ciascun anno, il market share di afatinib della stessa percentuale.
See this image and copyright information in PMC

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