Erlotinib or Docetaxel for Second-Line Treatment of Non-small Cell Lung Cancer A Real-World Cost-Effectiveness Analysis

Introduction: Erlotinib was recently approved in British Columbia (BC) as a second-line treatment for advanced NSCLC. A cost-effectiveness analysis was conducted which compares costs and effectiveness in patients who received second-line erlotinib with those in patients who received docetaxel. Methods: In a population of patients who have been treated with drugs (either erlotinib or docetaxel) for advanced NSCLC, overall survival (OS), progression-free survival (PFS), and probability of survival 1 year after beginning of second-line treatment (1YS) were determined using Kaplan-Meier and Cox proportional hazard analysis, as well as chi(2) test. Costs were collected retrospectively from the perspective of the BC health care system. Results: Incremental mean OS was 1 day, and incremental mean cost was $2891. Neither costs nor effectiveness were statistically significantly different between groups. PFS and 1YS were also nonsignificantly different. Cox proportional hazard models were used to evaluate multivariate confounding. Conclusions: Erlotinib and docetaxel are statistically equivalent in terms of treatment cost and overall survival. As treatment practice patterns change, docetaxel may become more frequently prescribed. Therefore, the choice of whether to use erlotinib or docetaxel should be based on factors relating to patient preference rather than costs or effectiveness.