Evidence map›Paper›PMID 26137881›Full record

Trial reportBMJ open2015

Cost-effectiveness of first-line erlotinib in patients with advanced non-small-cell lung cancer unsuitable for chemotherapy.

Iftekhar Khan, Stephen Morris, Allan Hackshaw, Siow-Ming Lee

Erratum issuedOpen access · goldAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ open, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 8 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 3 pooled it
3.3field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 3 syntheses or guidelines pooled it, 20 citations in OpenAlex.

  1. A systematic review of pharmacoeconomic evaluations of erlotinib in the first-line treatment of advanced non-small cell lung cancer.The European journal of health economics : HEPAC : health economics in prevention and care · 2019
    Pooled it
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  5. Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors at 2 institutions in 1 country.

Iftekhar KhanCRUK & UCL Cancer Trial Centre, University College London, London, UK Department of Applied Health Research, University College London, London, UK.
Stephen MorrisDepartment of Applied Health Research, University College London, London, UK.
Allan HackshawCRUK & UCL Cancer Trial Centre, University College London, London, UK.
Siow-Ming LeeUniversity College London Hospital/UCL Cancer Institute, London, UK.
University College London · GBUniversity College Hospital · GB

Funding

Cancer Research UK C1438/A4147
6 · The paper itself

Abstract

objectiveTo assess the cost-effectiveness of erlotinib versus supportive care (placebo) overall and within a predefined rash subgroup in elderly patients with advanced non-small-cell lung cancer who are unfit for chemotherapy and receive only active supportive care due to their poor performance status or presence of comorbidities.

settingBetween 2005 and 2009, a total of 670 patients with non-small cell lung cancer (NSCLC) were randomised across 78 hospital sites (centres) in the UK.

participants670 patients with pathologically confirmed stage IIIb-IV NSCLC, unfit for chemotherapy, predominantly poor performance status (>2 on Eastern Cooperative Oncology Group, ECOG) and estimated life expectancy of at least 8 weeks. Patients were followed until disease progression or death, including a subgroup of patients who developed first cycle rash.

interventionsPatients were randomised (1:1) to receive best supportive care plus oral placebo or erlotinib (150 mg/day) until disease progression, toxicity or death. PRIMARY OUTCOME: Overall survival (OS). SECONDARY OUTCOMES: Progression-free survival (PFS), tumour response and quality adjusted life years (QALY), including within prespecified subgroups.

resultsThe mean incremental cost per QALY in all patients was £202,571/QALY. The probability of cost-effectiveness of erlotinib in all patients was <10% at thresholds up to £100,000. However, within the rash subgroup, the incremental cost/QALY was £56,770/QALY with a probability of cost-effectiveness of about 80% for cost-effectiveness thresholds between £50,000 to £60,000.

conclusionsErlotinib has about 80% chance of being cost-effective at thresholds between £50,000-£60,000 in a subset of elderly poor performance patients with NSCLC unfit for chemotherapy who develop first cycle (28 days) rash. Erlotinib is potentially cost-effective for this population, for which few treatment options apart from best supportive care are available. TRIAL REGISTRATION NUMBER: (ISCRTN): 77383050.

Indexed as

AgedAged, 80 and overAntineoplastic AgentsCarcinoma, Non-Small-Cell LungCost-Benefit AnalysisDisease-Free SurvivalErlotinib HydrochlorideExanthemaFemaleHumansKaplan-Meier EstimateLung NeoplasmsMaleMiddle AgedQuality-Adjusted Life YearsAntineoplastic AgentsErlotinib HydrochlorideEPIDEMIOLOGYHEALTH ECONOMICSSTATISTICS & RESEARCH METHODS

Identifiers

PMID26137881
PMCPMC4499745
OpenAlexW2289132355

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.