PT  - JOURNAL ARTICLE
AU  - I. Borget
AU  - J. Cadranel
AU  - J-P. Pignon
AU  - E. Quoix
AU  - B. Coudert
AU  - V. Westeel
AU  - E. Dansin
AU  - J. Madelaine
AU  - A. Madroszyk
AU  - S. Friard
AU  - C. Daniel
AU  - F. Morin
AU  - C. Chouaid
AU  - the ERMETIC Collaborative Group
TI  - Comparative cost-effectiveness of three strategies for guiding second-line erlotinib initiation in non small-cell lung cancer: a French prospective multicenter study (ERMETIC Project Part 3)
AID  - 10.1183/09031936.00201210
DP  - 2011 Jan 01
TA  - European Respiratory Journal
PG  - erj02012-2010
4099  - http://erj.ersjournals.com/content/early/2011/06/09/09031936.00201210.short
4100  - http://erj.ersjournals.com/content/early/2011/06/09/09031936.00201210.full
AB  - Several clinical and biological parameters are known to influence the efficacy of second-line erlotinib therapy for non small-cell lung cancer (NSCLC), but their medico-economic impact has not been evaluated. The objective of this study was to compare the incremental cost-effectiveness ratios (ICERs) of strategies for second-line erlotinib initiation in NSCLC: clinically guided initiation (non smoker females with adenocarcinoma receive erlotinib, all other patients receive docetaxel) and biologically guided selection (patients with EGFR mutation receive erlotinib; patients with wild-type EGFR or unknown status receive docetaxel), compared to initiation with no patient selection (strategy reference).A Markov model was constructed. Outcomes (overall and progression-free survival), transition probabilities, and direct medical costs (from the French third-party payer's perspective) were prospectively collected for individual patients treated with erlotinib or docetaxel, from treatment initiation to disease progression. Published data were used to estimate utilities and post-progression costs. Sensitivity analyses were performed.The biologically and clinically guided strategies were both more efficient (incremental QALY respectively equal to 0.080 and 0.081) and less expensive (cost decrease respectively equal to 5020 and 5815 €) than the no-selection strategy, and the biologically guided strategy was slightly less expensive than the clinically guided strategy. Sensitivity analyses confirmed the robustness of the results.The cost-effectiveness of second-line NSCLC treatment is improved when patients are selected, on either clinical or biological grounds.