Comparative Cost-Effectiveness of Three First-Line Therapies for Egfr-Mutated Advanced Nsclc--Constructing a Cost-Effectiveness Estimating Platform

Objective: To construct a novel cost-effectiveness estimating platform for comparative cost-effectiveness of three first-line targeted therapies (gefitinib, erlotinib, afatinib) for EGFR-mutated advanced non-small cell lung cancer.Methods: The majority of analysis is from public payer’s perspective. A hospital cohort from May 2011 to April 2019 will be followed to collect the healthcare expenditures, which include National Health Insurance-reimbursed and out-of-pocket direct medical costs. The expenditures can be subdivided into costs attributable to therapies, adverse events, etc. EuroQol 5-dimension questionnaires are applied to repeatedly measure the utility values of quality of life along the treatment course and follow-up. After multiplying the progression-free survival and overall survival by the costs and utility values, we compare the cost-effectiveness by estimating the incremental cost-effectiveness ratio (ICER). One-way deterministic and probabilistic analyses will be conducted to exam the uncertainty, and we will construct linear mixed models or regressions to adjust for potential confounders.Expected impacts: We try to adopt a generalized cost-effectiveness analysis for the National Health Insurance and reduce the medical costs and sustain the healthcare system. Constructing the cost-effectiveness estimating platform can also be applied to other health technology assessments, e.g., cost-effectiveness of using osimertinib as first-line targeted therapy, and comparative cost-effectiveness among different immune checkpoint inhibitors.