Epidermal Growth Factor Receptor Mutation Testing in Thailand: A Cost-Utility Analysis

Area of Science:

• Pharmacoeconomics
• Oncology
• Health Technology Assessment

Background:

• Epidermal growth factor receptor (EGFR) mutations are common in non-small cell lung cancer (NSCLC).
• Targeted therapies like gefitinib offer improved outcomes for patients with activating EGFR mutations.
• Cost-effectiveness of diagnostic testing and targeted therapy needs evaluation in specific healthcare settings.

Purpose of the Study:

• To assess the cost utility of EGFR testing followed by first-line gefitinib treatment in Thai NSCLC patients with activating EGFR mutations.
• To compare this strategy against no upfront EGFR testing.

Main Methods:

• A decision tree model was employed from a healthcare provider's perspective.
• Direct medical costs were sourced from a local Thai database.
• Effectiveness was measured in quality-adjusted life-years (QALYs) based on randomized controlled trial data.
• Incremental cost-effectiveness ratio (ICER) was calculated and sensitivity analyses were performed.

Main Results:

• EGFR testing plus first-line gefitinib yielded 0.03 additional QALYs.
• This strategy resulted in lower total costs by 62,540 Thai Baht (approximately US $2082.58).
• Results remained robust across sensitivity analyses, with exceptions for treatment durations and second-line chemotherapy utility.

Conclusions:

• EGFR testing is recommended prior to initiating first-line gefitinib treatment for NSCLC patients in Thailand.
• This approach is particularly relevant given the high incidence of EGFR mutations in the Thai population.
• The strategy demonstrates both clinical and economic benefits.