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Abstract
Introduction: Lung cancer remains a leading cause of death worldwide, with non-small cell lung cancer (NSCLC) carrying the highest incidence among lung cancer types, particularly in patients with epidermal growth factor receptor (EGFR) mutations. The first-line therapy for NSCLC lung cancer patients with EGFR mutations typically involves the tyrosine kinase inhibitor (TKI) group.
Objective: The study aimed to compare the cost utility of the two TKI groups (afatinib and erlotinib) for NSCLC patients with EGFR mutations.
Methods: This pharmacoeconomic study was conducted using the Cost Utility Analysis (CUA) method from the patient’s perspective. The study included 33 patients receiving afatinib and 12 patients receiving erlotinib, conducted in 2022-2023 at Kariadi Hospital, Semarang, and Prof. Dr. Margono Soekarjo Hospital, Purwokerto. Therapeutic outcomes were measured using Quality Adjusted Life Year (QALY), and cost components included actual costs and estimated costs based on clinical pathways. CUA was presented in the form of an Incremental Cost Effectiveness Ratio (ICER).
Results: The cost of afatinib was greater than that of erlotinib (IDR 174.395.847 vs. IDR 138.672.688). The quality of life of afatinib was better than that of erlotinib (0.397 vs. 0.161, p-value 0.016). The ICER of afatinib was IDR 151.369.318 per QALY when compared to erlotinib.
Conclusion: This study demonstrates that afatinib is a cost-effective treatment option for NSCLC patients with EGFR mutations.
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References
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Brueckl, W.M., Achenbach, H.J., Ficker, J.H., Schuette, W., 2018. Erlotinib treatment after platinum-based therapy in elderly patients with non-small-cell lung cancer in routine clinical practice - results from the ElderTac study. BMC Cancer 18, 1–11. https://doi.org/10.1186/s12885-018-4208-x
Cagle, P.T., Allen, T.C., Olsen, R.J., 2013. Lung cancer biomarkers: present status and future developments. Arch. Pathol. Lab. Med. 137, 1191–1198. https://doi.org/10.5858/arpa.2013-0319-CR
De Man, Y., Atsma, F., Oosterveld-Vlug, M.G., Brom, L., Onwuteaka-Philipsen, B.D., Westert, G.P., Groenewoud, A.S., 2019. The Intensity of Hospital Care Utilization by Dutch Patients With Lung or Colorectal Cancer in their Final. Cancer Control 26, 1–9. https://doi.org/10.1177/1073274819846574
Dwilovianita, Y., Annisa, E., Parlaungan, B., Sihite, S., Pranata, H., Ginting, N., Keperawatan, F., Kebidanan, D., 2022. Hubungan Karakteristik Nyeri Dan Kecemasan Pasien Yang Menjalani Kemoterapi. J. Penelit. Perawat Prof. 4, 17–26.
Ettinger, D.S., Wood, D.E., Aisner, D.L., Akerley, W., Bauman, J.R., Bharat, A., Bruno, D.S., Chang, J.Y., Chirieac, L.R., D’Amico, T.A., Dilling, T.J., Dowell, J., Gettinger, S., Gubens, M.A., Hegde, A., Hennon, M., Lackner, R.P., Lanuti, M., Leal, T.A., Lin, J., Loo, B.W., Lovly, C.M., Martins, R.G., Massarelli, E., Morgensztern, D., Ng, T., Otterson, G.A., Patel, S.P., Riely, G.J., Schild, S.E., Shapiro, T.A., Singh, A.P., Stevenson, J., Tam, A., Yanagawa, J., Yang, S.C., Gregory, K.M., Hughes, M., 2021. Non-small cell lung cancer, Version 2.2021 featured updates to the NCCN guidelines. JNCCN J. Natl. Compr. Cancer Netw. 19, 254–266. https://doi.org/10.6004/jnccn.2021.0013
Ardhila, N.F., Endarti, D., Phodha, T., 2024. Systematic Review of Economic Evaluation Studies of Stroke Disease: Cost Effectiveness. J. Heal. Econ. Policy Res. 2, 27–34. https://doi.org/10.30595/jhepr.v2i1.110
Fujiwara, A., Yoshida, M., Fujimoto, H., Nakahara, H., Ito, K., Nishihama, K., Yasuma, T., Hataji, O., Taguchi, O., D’Alessandro-Gabazza, C.N., Gabazza, E.C., Kobayashi, T., 2018. A retrospective comparison of the clinical efficacy of gefitinib, erlotinib, and afatinib in Japanese patients with non-small cell lung cancer. Oncol. Res. 26, 1031–1036. https://doi.org/10.3727/096504018X15151523767752
Globocan, 2020. Lung Fact Sheet. Glob. Obs. Cancer 419, 1–2.
Globocan Asia, 2021. Asia : Globocan 2020 Summary Statistic. Int. Agency Res. Cancer 136, 2.
Gu, X., Zhang, Q., Chu, Y.B., Zhao, Y.Y., Zhang, Y.J., Kuo, D., Su, B., Wu, B., 2019. Cost-effectiveness of afatinib, gefitinib, erlotinib and pemetrexed-based chemotherapy as first-line treatments for advanced non-small cell lung cancer in China. Lung Cancer 127, 84–89. https://doi.org/10.1016/j.lungcan.2018.11.029
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Hamida, N., Ulfa, M., Haris, R.N.H., Endarti, D., Wiedyaningsih, C., 2019. Pengukuran Kualitas Hidup Pasien Program Pengelolaan Penyakit Kronis (Prolanis) di Puskesmas Menggunakan Instrumen EQ-5D-5L. Maj. Farm. 15, 67. https://doi.org/10.22146/farmaseutik.v15i2.46328
Hsu, L.H., Chu, N.M., Kao, S.H., 2017. Estrogen, estrogen receptor and lung cancer. Int. J. Mol. Sci. 18, 1–17. https://doi.org/10.3390/ijms18081713
Joseph, J., Rotty, L.W.A., 2020. Kanker Paru: Laporan Kasus. Med. Scope J. 2, 17–25. https://doi.org/10.35790/msj.v2i1.31108
Kim, Y., Lee, S.H., Ahn, J.S., Ahn, M.J., Park, K., Sun, J.M., 2019. Efficacy and safety of afatinib for EGFR-mutant non-small cell lung cancer, compared with gefitinib or erlotinib. Cancer Res. Treat. 51, 502–509. https://doi.org/10.4143/crt.2018.117
Kim, Y.J., Oremus, M., Chen, H.H., McFarlane, T., Fearon, D., Horton, S., 2021. Cost-Effectiveness Analysis of Afatinib, Erlotinib, and Gefitinib as First-Line Treatments for EGFR Mutation-Positive Non-Small-Cell Lung Cancer in Ontario, Canada. Pharmacoeconomics 39, 537–548. https://doi.org/10.1007/s40273-021-01022-9
Lukeman, J.M., 2015. What Is Lung Cancer? Perspect. Lung Cancer 30–40. https://doi.org/10.1159/000400400
Maemondo, M., Inoue, A., Kobayashi, K., Sugawara, S., Oizumi, S., Isobe, H., Gemma, A., Harada, M., Yoshizawa, H., Kinoshita, I., Fujita, Y., Okinaga, S., Hirano, H., Yoshimori, K., Harada, T., Ogura, T., Ando, M., Miyazawa, H., Tanaka, T., Saijo, Y., Hagiwara, K., Morita, S., Nukiwa, T., 2012. Gefitinib or Chemotherapy for Non–Small- Cell Lung Cancer with Mutated EGFR.
Nasrulsyah, C., Asyura, F., Hasan, K., Maulidani, Sofia, M., 2020. Analisis Swot Dalam Mengatasi Kelemahan Dan Kekurangan Rumah Sakit Siloam. Makma 3, 112–118.
Novello, S., Barlesi, F., Califano, R., Cufer, T., Ekman, S., Levra, M.G., Kerr, K., Popat, S., Reck, M., Senan, S., Simo, G. V., Vansteenkiste, J., Peters, S., on behalf of the ESMO Guidelines Committee, 2016. Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 27, V1–V27. https://doi.org/10.1093/annonc/mdw326
Nurhayati, F., Anggriani, Y., Syahruddin, E., Ramadaniati, H.U., Kusumaeni, T., 2021. Cost-effectiveness analysis of tyrosine kinase inhibitors (erlotinib vs. gefitinib vs. afatinib) in non-small-cell lung cancer. J. Appl. Pharm. Sci. 11, 88–95. https://doi.org/10.7324/JAPS.2021.110411
Oktaviyanti, I.K., 2015. Mutasi egfr pada pemeriksaan sitologi adenokarsinoma paru. Berk. Kedokt. 11, 213–219.
Pritami, A.A., Soemarwoto, R.A.S., Wintoko, R., 2022. Faktor Risiko Kanker Paru : Tinjauan Pustaka. J. Agromedicine 9, 120–123.
Putriani, F.A., Kholis, F.N., Purwoko, Y., 2019. Perbedaan Faktor Risiko Penderita Adenokarsinoma Paru Dengan Mutasi Egfr Dan Non Mutasi Egfr. Diponegoro Med. J. (Jurnal Kedokt. Diponegoro) 8, 214–221.
Restyana, A., Admaja, W., Studi Farmasi, P., Ilmu Kesehatan, F., Kadiri, U., Jl Selomangleng No, K., Mojoroto Kota Kediri, P., 2019. Analisa Biaya Penggunaan Seftriakson dan Siprofloksasin Pasien Infeksi Saluran Kemih di Rumah Sakit X Kabupaten Jombang Tahun 2017 Cost Analysis of Ceftriaxone and Ciprofloxacin on Urinary Tract Infection Patients at X Hospital in Jombang 2017. Pharm. J. Indones. 16, 1–9.
Robot, R.Y., Durry, M.F., Kairupan, C.F., 2021. Morfologi, Patogenesis, dan Imunoterapi Kanker Paru Tipe Adenokarsinoma. Med. Scope J. 3, 74. https://doi.org/10.35790/msj.v3i1.33544
Sulviana, E.R., Kurniasari, L., 2021. Hubungan Antara Usia, Pendidikan, dan Pekerjaan dengan Kejadian Kanker Payudara pada Wanita di Kalimantan Timur. Borneo Student Res. 2, 1937–1943.
Sutnick, A.I., Gunawan, S., 1982. Cancer in Indonesia. JAMA J. Am. Med. Assoc. 247, 3087–3088. https://doi.org/10.1001/jama.247.22.3087
Tezel, G.G., Şener, E., Aydın, Ç., Önder, S., 2017. Prevalence of epidermal growth factor receptor mutations in patients with non-small cell lung cancer in Turkish population. Balkan Med. J. 34, 567–571. https://doi.org/10.4274/balkanmedj.2017.0297
Wulandari, A., Monalisa, S., Zaini, J., 2019. Analisis Biaya Kemoterapi Lini Pertama Pada Pasien Kanker Paru di Rumah Sakit Persahabatan Jakarta Timur Periode Tahun 2016. Sainstech Farma 12, 85–92.
Wulandari, F., Utami, W., Rohana, E., Prabhata, W.R., 2021. Efikasi Terapi. J. Res. Pharm. 1, 25–33.
Yang, Z., Hackshaw, A., Feng, Q., Fu, X., Zhang, Y., Mao, C., Tang, J., 2017. Comparison of gefitinib, erlotinib and afatinib in non-small cell lung cancer: A meta-analysis. Int. J. Cancer 140, 2805–2819. https://doi.org/10.1002/ijc.30691
You, J.H.S., Cho, W.C.S., Ming, W.K., Li, Y.C., Kwan, C.K., Au, K.H., Au, J.S.K., 2021. EGFR mutation-guided use of afatinib, erlotinib and gefitinib for advanced non-small-cell lung cancer in Hong Kong - A cost-effectiveness analysis. PLoS One 16, 1–14. https://doi.org/10.1371/journal.pone.0247860
Zhu, J., He, W., Ye, M., Fu, J., Chu, Y.B., Zhao, Y.Y., Zhang, Y.J., Kuo, D., Wu, B., 2018. Cost-effectiveness of afatinib and erlotinib as second-line treatments for advanced squamous cell carcinoma of the lung. Futur. Oncol. 14, 2833–2840. https://doi.org/10.2217/fon-2018-0321