Evidence map›Paper›PMID 29654023›Full record

Trial reportBMJ open2018

OPTIMAL and ENSURE trials-based combined cost-effectiveness analysis of erlotinib versus chemotherapy for the first-line treatment of Asian patients with non-squamous non-small-cell lung cancer.

Feng Wen, Hanrui Zheng, Pengfei Zhang, David Hutton, Qiu Li

Registry-linked trialOpen access · goldAbstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01342965 (A Multicenter, Open-label, Randomized Phase III Study to Evaluate the Efficacy and Safety of Erlotinib), which is not on this map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
1.6field-weighted citation impact, top 16% 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.

NCT01342965 phase3completednot on this map

A Multicenter, Open-label, Randomized Phase III Study to Evaluate the Efficacy and Safety of Erlotinib (Tarceva®) Versus Gemcitabine/Cisplatin as the First-line Treatment for Stage IIIB/IV Non-small Cell Lung Cancer (NSCLC) Patients With Mutations in the Tyrosine Kinase Domain of Epidermal Growth Factor Receptor (EGFR) in Their Tumors

TypeinterventionalSponsorHoffmann-La RocheRan2011 to 2014Enrolled217ConditionsNon-Small Cell Lung CancerArmsErlotinib, Chemotherapy
3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 14 citations in OpenAlex.

  1. Article
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  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 2 countries.

Feng Wen *Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Hanrui Zheng *West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, China.
Pengfei ZhangWest China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, China.
David HuttonDepartment of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA.
Qiu LiDepartment of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Sichuan University · CNUniversity of Michigan–Ann Arbor · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesErlotinib, the first generation of epidermoid growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), has been recommended as an essential treatment in patients with non-small-cell lung cancer (NSCLC) with EGFR mutation. Although it has improved progression-free survival (PFS), overall survival (OS) was limited and erlotinib can be expensive. This cost-effectiveness analysis compares erlotinib monotherapy with gemcitabine-included doublet chemotherapy.

settingFirst-line treatment of Asian patients with NSCLC with EGFR mutation.

methodsA Markov model was created based on the results of the ENSURE (NCT01342965) and OPTIMAL (CTONG-0802) trials which evaluated erlotinib and chemotherapy. The model simulates cancer progression and all causes of death. All medical costs were calculated from the perspective of the Chinese healthcare system.

main outcome measuresThe primary outcomes are costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs).

resultsThe combined PFS was 11.81 months and 5.1 months for erlotinib and chemotherapy, respectively, while the OS was reversed at 24.68 months for erlotinib and 26.16 months for chemotherapy. The chemotherapy arm gained 0.13 QALYs compared with erlotinib monotherapy (1.17 QALYs vs 1.04 QALYs), while erlotinib had lower costs ($55 230 vs $77 669), resulting in an ICER of $174 808 per QALY for the chemotherapy arm, which exceeds three times the Chinese GDP per capita. The most influential factors were the health utility of PFS, the cost of erlotinib and the health utility of progressed disease.

conclusionErlotinib monotherapy may be acceptable as a cost-effective first-line treatment for NSCLC compared with gemcitabine-based chemotherapy. The results were robust to changes in assumptions. TRIAL REGISTRATION NUMBER: NCT01342965 and CTONG-0802.

Indexed as

Antineoplastic AgentsAntineoplastic Combined Chemotherapy ProtocolsCarcinoma, Non-Small-Cell LungErlotinib HydrochlorideLung NeoplasmsCost-Benefit AnalysisErbB ReceptorsHumansMassachusettsProtein Kinase InhibitorsQuinazolinesAntineoplastic AgentsErbB ReceptorsErlotinib HydrochlorideProtein Kinase InhibitorsQuinazolineschemotherapycost-effectivenesserlotinibnon– small-cell lung cancer

Identifiers

PMID29654023
PMCPMC5905764
OpenAlexW2797250355

What OpenQuestion holds

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Registered trials

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.