Erlotinib for the treatment of relapsed non-small cell lung cancer

McLeod C, Bagust A, Boland A, Hockenhull J, Dundar Y, Proudlove C, Davis H, Green J, Macbeth F, Stevenson J, Walley T, Dickson R
Record ID 32011000824
English
Authors' recommendations: The manufacturer’s submission presents a case for the replacement of docetaxel by erlotinib as second-line chemotherapy for NSCLC patients with advanced or metastatic disease. However, there is a proportion of NSCLC patients whose poor health status precludes them from receiving docetaxel; for these patients best supportive care is currently the only treatment option available. It may be argued that some of these patients could be considered for erlotinib instead of docetaxel as it is a less demanding oral regimen.The ERG attempted to rectify several of the limitations in the clinical and cost-effectiveness evidence submitted, generating much higher incremental cost-effectiveness ratios than those generated in the manufacturer’s submission (in excess of £52,000). This extreme sensitivity is due to the very small value of incremental benefit, which renders the ICER highly unstable to small changes. There is still a large amount of unquantifiable uncertainty, however at the current price it is unlikely that erlotinib could be considered to be cost effective compared with docetaxel at a WTP of £30,000. There may even be the potential for docetaxel to dominate erlotinib (i.e. be more effective yet less expensive). This means that adoption of erlotinib would need to be justified on grounds out with the factors included in the model (for example, patient preference for oral self-medication and service pressures to limit or reduce demand for hospital administered chemotherapy).Given the limitations of the indirect analysis undertaken by the manufacturer and the subsequent economic modelling exercise there is a need for a head-to-head trial comparing erlotinib with docetaxel.
Details
Project Status: Completed
URL for project: http://www.hta.ac.uk/1640
Year Published: 2009
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Protein Kinase Inhibitors
  • Quinazolines
  • Carcinoma, Non-Small-Cell Lung
  • Lung Neoplasms
Contact
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name: journals.library@nihr.ac.uk
Contact Email: journals.library@nihr.ac.uk
Copyright: 2009 Queen's Printer and Controller of HMSO
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