The value of targeted therapies in non-small-cell lung cancer
The value of targeted therapies in non-small-cell lung cancer
Lung cancer is the leading cause of cancer-related mortality worldwide, with 80–90% of cases classified as non-small-cell lung cancer (NSCLC). Over the past decade, treatment has shifted from chemotherapy to targeted therapies directed at molecular alterations such as ALK, EGFR, ROS1, and PD-(L)1. While these therapies improve survival, they also increase healthcare costs.
The first part of this thesis of Lotte Westerink evaluated the health economic value of targeted therapies through a review of NICE technology appraisals and the use of utility values in QALY estimation. Appraisals became increasingly complex, incorporating multiple indications, subpopulations, and comparators. Although most therapies were recommended for reimbursement, substantial variation existed in the selection and application of utility values. In addition, age-specific analyses were lacking despite mutation-driven NSCLC increasingly affecting younger patients.
The second part assessed targeted therapies through cost-effectiveness and budget impact analyses. First-line lorlatinib showed a low probability of being cost-effective at the current list price compared with crizotinib or alectinib in ALK-positive NSCLC. In contrast, first-line afatinib followed by osimertinib resulted in lower costs and better long-term outcomes than first-line osimertinib followed by chemotherapy in EGFR-mutated NSCLC. A complementary case study found nintedanib to be cost-effective for progressive fibrosing interstitial lung disease, a condition relevant to NSCLC as both a comorbidity and treatment-related adverse event.
Overall, the findings support a more holistic, sequence-based approach to economic evaluation that incorporates quality of life, long-term adverse events, and age-specific considerations.