Research Journal of Pharmacy and Technology

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Cost-effectiveness Analysis of Afatinib Versus Gefitinib in Non-small Cell Lung Cancer (Nsclc) with Epidermal Growth Factor Receptor (Egfr) Mutation in Indonesia: Observational Studies with Retrospectives


Affiliations
1 Sekolah Tinggi Ilmu Farmasi Riau, Pekanbaru,, Indonesia
2 Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia
3 Department of Pharmaceutics, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta,, Indonesia
4 Department of Internal Medicine, Division of Hematology and Medical Oncology, Faculty of Medicine Gadjah Mada University - Dr. Sardjito Hospital, Yogyakarta,, Indonesia
     

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Background: A cost effectiveness study is a method in pharmacoeconomic research that can be used as a reference for decision makers or clinicians in determining effective and efficient treatment for patients, one of which is a Non-Small Cell Lung Cancer patient who has an EGFR mutation. Research related to the cost effectiveness of the benefits afatinib and gefitinib is still very limited, especially in Indonesia. This study aims to determine the cost-effectiveness of afatinib versus gefitinib in NSCLC with EGFR mutation patients. Methods and Material: This study is an observational study with a retrospective approach that observes medical record records (to determine clinical outcomes) and financial records (to determine direct medical costs) in NSCLC patients with EGFR mutations at dr Sardjito Hospital Yogyakarta and Dr Kariadi Hospital Semarang, Java Island., Indonesia in the period January 2016 - June 2019. Result: Direct medical cost for NSCLC patients with EGFR mutations who received afatinib therapy was an average of Rp. 120,881,289, - ± 5,353,480.07 per patient, while those who received gefitinib therapy were an average of 90,750,186, - ± 3,369,967,722. Effectiveness data have been published in previous studies. The ICER PFS value shows that afatinib is cost-effectiveness compared to gefitinib with a value of Rp. 106, 345, 069.4/PFS (year). This ICER value is less than 2 times the value of Gross Domestic Product/GDP (Rp. 118, 200,000, -) which is around 1.8 times the value of GDP, whereas in OS afatinib is no better than gefitinib. Conclusion: Afatinib cost effectiveness based on real world retrospectively compared to gefitinib with ICER PFS value of Rp. 106, 345, 069.4/year.

Keywords

Cost effectiveness analysis, Afatinib, Gefitinib, NSCLC.
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  • Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [Internet]. CA: A Cancer Journal for Clinicians. 2018 [cited 2019 Sep 2]. Available from: https://onlinelibrary.wiley.com/doi/abs/10.3322/caac.21492

  • Chouaid C, Dujon C, Do P, Monnet I, Madroszyk A, Le Caer H, et al. Feasibility and clinical impact of re-biopsy in advanced non small-cell lung cancer: A prospective multicenter study in a real-world setting (GFPC study 12-01). Lung Cancer. 2014 Nov 1;86(2):170–3.

  • Shi Y, Li J, Zhang S, Wang M, Yang S, Li N, et al. Molecular Epidemiology of EGFR Mutations in Asian Patients with Advanced Non-Small-Cell Lung Cancer of Adenocarcinoma Histology – Mainland China Subset Analysis of the PIONEER study. Chai KX, editor. PLOS ONE. 2015 Nov 23;10(11):e0143515.

  • Ettinger DS, Wood DE, Aggarwal C, Aisner DL, Akerley W, Bauman JR, et al. NCCN Guidelines Insights: Non-Small Cell Lung Cancer, Version 1.2020. J Natl Compr Cancer Netw JNCCN. 2019 Dec;17(12):1464–72.

  • Chi A, Remick S, Tse W. EGFR inhibition in non-small cell lung cancer: current evidence and future directions. Biomark Res [Internet]. 2013 Dec [cited 2019 Apr 30];1(1). Available from: https://biomarkerres.biomedcentral.com/articles/10.1186/2050-7771-1-2

  • Solca F, Dahl G, Zoephel A, Bader G, Sanderson M, Klein C, et al. Target Binding Properties and Cellular Activity of Afatinib (BIBW 2992), an Irreversible ErbB Family Blocker. J Pharmacol Exp Ther. 2012 Nov 1;343(2):342–50.

  • V Kiran Kumar, N Appala Raju, Shabana Begum, Jvln Seshagiri Rao, T Satyanarayana. The Estimation of Gefitinib in Tablet Dosage Forms by RP-HPLC. Research J. Pharm. and Tech.2 (2): April.-June.2009; Page 341-343.

  • Pramadvara Kallepalli, Mukthinuthalapati Mathrusri Annapurna. Separation, Identification and Quantification of process related Impurities and Stress Degradants of Gefitinib by LC-ESI-Q–TOF/MS. Research J. Pharm. and Tech 2018; 11(8): 3647-3657.

  • Lee J-K, Hahn S, Kim D-W, Suh KJ, Keam B, Kim TM, et al. Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors vs Conventional Chemotherapy in Non–Small Cell Lung Cancer Harboring Wild-Type Epidermal Growth Factor Receptor: A Meta-analysis. JAMA. 2014 Apr 9;311(14):1430–7.

  • Sari S, Andayani TM, Endarti D, Widayati K. Efikasi Afatinib dan Gefitinib pada Pasien Non-small Cell Lung Cancer EGFR Mutasi Positif: Tinjauan Sistematis. Indones J Clin Pharm. 2019 Dec 29;8(4):289.

  • Li H. Efficacy of EGFR Tyrosine Kinase Inhibitors in Non-Small-Cell Lung Cancer Patients with/without EGFR-Mutation: Evidence Based on Recent Phase III Randomized Trials. Med Sci Monit. 2014;20:2666–76.

  • Sari S, Andayani TM, Endarti D, Widayati K. Health-Related Quality of Life in Non-Small Cell Lung Cancer (NSCLC) Patients with Mutation of Epidermal Growth Factor Receptor (EGFR) in Indonesia. Res J Pharm Technol. 2020;13(1):443.

  • Park K, Tan E-H, O’Byrne K, Zhang L, Boyer M, Mok T, et al. Afatinib versus gefitinib as first-line treatment of patients with EGFR mutation-positive non-small-cell lung cancer (LUX-Lung 7): a phase 2B, open-label, randomised controlled trial. Lancet Oncol. 2016 May;17(5):577–89.

  • Paz-Ares L, Tan E-H, O’Byrne K, Zhang L, Hirsh V, Boyer M, et al. Afatinib versus gefitinib in patients with EGFR mutation-positive advanced non-small-cell lung cancer: overall survival data from the phase IIb LUX-Lung 7 trial. Ann Oncol. 2017 Feb 1;28(2):270–7.

  • Liang W, Wu X, Fang W, Zhao Y, Yang Y, Hu Z, et al. Network Meta-Analysis of Erlotinib, Gefitinib, Afatinib and Icotinib in Patients with Advanced Non-Small-Cell Lung Cancer Harboring EGFR Mutations. Ganti AK, editor. PLoS ONE. 2014 Feb 12;9(2):e85245.

  • Sari S, Andayani TM, Endarti D, Widayati K. Effectiveness of Afatinib and Gefitinib in Non-Small Cell Lung Cancer (NSCLC) Epidermal Growth Factor Receptor (EGFR) Mutations in Indonesia: Observational Studies with Retrospectives. Int J Res Pharm Sci. 2019 Nov 8;10(4):3516–22.

  • Wang H, Zeng C, Li X, Wang Y, Li X, Ge W. Cost-utility of afatinib and gefitinib as first-line treatment for EGFR -mutated advanced non-small-cell lung cancer. Future Oncol. 2019 Jan;15(2):181–91.

  • Arrieta O, Catalán R, Guzmán-Vazquez S, Barrón F, Lara-Mejía L, Soto-Molina H, et al. Cost-effectiveness analysis of first and second-generation EGFR tyrosine kinase inhibitors as first line of treatment for patients with NSCLC harboring EGFR mutations. BMC Cancer [Internet]. 2020 Dec [cited 2021 Jan 13];20(1). Available from: https://bmccancer.biomedcentral.com/articles/10.1186/s12885-020-07329-8

  • Zhu J, Ye M, Fu J, Wu B, Chu Y, Zhao Y, et al. Cost-Effectiveness of Afatinib, Gefitinib, Erlotinib, and Pemetrexed-Based Chemotherapy as First-Line Treatments for Egfr Mutation Positive, Advanced Non-Small Cell Lung Cancer in China. Value Health. 2017 Oct 1;20(9):A440–1.

  • Tanaka H, Taima K, Itoga M, Ishioka Y, Baba K, Shiratori T, et al. Real-world study of afatinib in first-line or re-challenge settings for patients with EGFR mutant non-small cell lung cancer. Med Oncol Northwood Lond Engl. 2019 May 14;36(6):57.

  • Migliorino MR, Santo A, Romano G, Cortinovis D, Galetta D, Alabiso O, et al. Economic burden of patients affected by non-small cell lung cancer (NSCLC): the LIFE study. J Cancer Res Clin Oncol. 2017 May;143(5):783–91.

  • Mukesh K. Nag, Satish Patel, Rajnikant Panik, Shikha Shrivastava, Sanjay J. Daharwal, Manju R. Singh, Deependra Singh. Lung Cancer Targeting: A Review. Research J. Pharm. and Tech. 6(11): November 2013; Page 1302-1306.

  • Chandrasekhar Chanda. Role of Inflammatory Cytokines during Lung Cancer Progression: A Review. Research J. Pharm. and Tech 2018; 11(11): 5163-5165

  • Deepak Rao Khadatkar, Yogesh Rathore . An Efficient and Useful Hybrid Approach for Detection of Lung Cancer. Research J. Engineering and Tech. 2(4):Oct.-Dec. 2011 page199-202.

  • Kementerian kesehatan Republik Indonesia. Buku panduan penilaian teknologi kesehatan. Komite Penilaian Teknologi Kesehatan; 2017.

  • Imani A, Janati A, Moghimi M, Golestani M, Doshmangir L. Identification of Indicators for Evaluating the Financial and Economic Performance of the Pharmacy: A Systematic Review. Pharm Sci. 2015 Aug 9;21(2):111–24.

  • Kim Y, Lee S-H, Ahn JS, Ahn M-J, Park K, Sun J-M. Efficacy and Safety of Afatinib for EGFR-mutant Non-small Cell Lung Cancer, Compared with Gefitinib or Erlotinib. Cancer Res Treat Off J Korean Cancer Assoc. 2019 Apr;51(2):502–9.

  • Kaushal Patidar, Ankita Chaudhari. A Study to Assess the Effectiveness of Planned Teaching Programe on Knowledge regarding prevention of Lung Cancer among Industrial Workers in selected Industry of Mehsana District.Asian J. Nursing Education and Research. 2019; 9(3):346-348.

  • Ghadge Dhairyasheel, Yadav Adhikrao, Gharge Varsha. Design and Development of Solid Self-Microemulsifying Drug Delivery of Gefitinib. Asian J. Pharm. Tech. 2018; 8 (4):193-199.

  • Fujiwara A, Yoshida M, Fujimoto H, Nakahara H, Ito K, Nishihama K, et al. A Retrospective Comparison of the Clinical Efficacy of Gefitinib, Erlotinib, and Afatinib in Japanese Patients With Non-Small Cell Lung Cancer. Oncol Res Featur Preclin Clin Cancer Ther. 2018 Aug 23;26(7):1031–6.

  • Reshma Thomas, R. Hari, Josna Joy, Saranya Krishnan, Swathy A.N, Sruthy. S. Nair, Asha Asokan Manakadan, Sathianarayanan, Saranya T.S. In silico Docking Approach of Coumarin Derivatives as an Aromatase Antagonist. Research J. Pharm. and Tech. 8(12): Dec., 2015; Page 1673-1678.


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  • Cost-effectiveness Analysis of Afatinib Versus Gefitinib in Non-small Cell Lung Cancer (Nsclc) with Epidermal Growth Factor Receptor (Egfr) Mutation in Indonesia: Observational Studies with Retrospectives

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Authors

Seftika Sari
Sekolah Tinggi Ilmu Farmasi Riau, Pekanbaru,, Indonesia
Tri Murti Andayani
Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia
Dwi Endarti
Department of Pharmaceutics, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta,, Indonesia
Kartika Widayati
Department of Internal Medicine, Division of Hematology and Medical Oncology, Faculty of Medicine Gadjah Mada University - Dr. Sardjito Hospital, Yogyakarta,, Indonesia

Abstract


Background: A cost effectiveness study is a method in pharmacoeconomic research that can be used as a reference for decision makers or clinicians in determining effective and efficient treatment for patients, one of which is a Non-Small Cell Lung Cancer patient who has an EGFR mutation. Research related to the cost effectiveness of the benefits afatinib and gefitinib is still very limited, especially in Indonesia. This study aims to determine the cost-effectiveness of afatinib versus gefitinib in NSCLC with EGFR mutation patients. Methods and Material: This study is an observational study with a retrospective approach that observes medical record records (to determine clinical outcomes) and financial records (to determine direct medical costs) in NSCLC patients with EGFR mutations at dr Sardjito Hospital Yogyakarta and Dr Kariadi Hospital Semarang, Java Island., Indonesia in the period January 2016 - June 2019. Result: Direct medical cost for NSCLC patients with EGFR mutations who received afatinib therapy was an average of Rp. 120,881,289, - ± 5,353,480.07 per patient, while those who received gefitinib therapy were an average of 90,750,186, - ± 3,369,967,722. Effectiveness data have been published in previous studies. The ICER PFS value shows that afatinib is cost-effectiveness compared to gefitinib with a value of Rp. 106, 345, 069.4/PFS (year). This ICER value is less than 2 times the value of Gross Domestic Product/GDP (Rp. 118, 200,000, -) which is around 1.8 times the value of GDP, whereas in OS afatinib is no better than gefitinib. Conclusion: Afatinib cost effectiveness based on real world retrospectively compared to gefitinib with ICER PFS value of Rp. 106, 345, 069.4/year.

Keywords


Cost effectiveness analysis, Afatinib, Gefitinib, NSCLC.

References