P044 Cost-Effectiveness Analysis of Icotinib vs Whole-Brain Irradiation in NSCLC Patients with Brain Metastases

Non-small-cell lung cancer (NSCLC) patients with brain metastases had a poor prognosis and quality of life. Despite the traditional methods including radiotherapy and chemotherapy, epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) might benefit patients on survival and quality of life. We investigated the cost-effectiveness of icotinib compared with WBI with or without chemotherapy for NSCLC patients with brain metastases. A markov model was conducted based on the data of BRAIN trial. We compared the economic benefit among icotinib, whole-brain irradiation (WBI) alone group, WBI plus chemotherapy group, and the combination of WBI and WBI plus chemotherapy group. We considered disease progression as intracranial progression and overall progression separately. Sensitivity analyses were performed to observe the stability of the model. The willingness-to-pay (WTP) was set as 3× per capita gross domestic product ($25929/quality-adjusted life year [QALY]). When considering progression as intracranial progression and overall progression respectively, the incremental cost-effectiveness ratio (ICER) was $822.57/QALY and $763.03/QALY between icotinib and WBI; $908.14/QALY and $837.65/QALY between icotinib with WBI-chemotherapy; $881.55 /QALY and $814.5/ QALY between icotinib and WBI/WBI-chemotherapy. Besides, both of the average cost-effective ratio (average CE) and net benefit showed advantage of icotinib (average CE: $2193.43/QALY for intracranial progression, $2338.10/QALY for overall progression; net benefit: $395728.16 for intracranial progression, $368976.82 for overall progression). One-way sensitivity analyses demonstrated the importance of the utilities of icotinib group. The probabilistic sensitivity analyses showed even at a WTP under $6000/QALY, icotinib could be cost-effective comparing with WBI. Icotinib was cost-effective compared with WBI with or without chemotherapy.