A decision model was developed to compare the cost-effectiveness of afatinib versus erlotinib in the first-line treatment of patients with metastatic non–small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 19 deletion (Del19) mutations. The framework of the model was that of a partitioned survival model. Patients entered the model in the progression-free disease state initiating first-line treatment. In each cycle of the model, patients either remained in the progression-free disease state or advanced to the progressive disease or death state based on progression-free and overall survival curves. The model was populated with data from published literature, publicly available sources, and clinical trials. The results showed that patients taking afatinib accrued more life-years (3.09 vs 2.46) and quality-adjusted life-years (QALYs) (2.16 vs 1.72) than patients taking erlotinib. Total per-patient costs were $246,801 with afatinib and $212,466 with erlotinib. The incremental cost per life-year gained for afatinib versus erlotinib was $52,401. Afatinib was cost-effective at a threshold of $150,000, with an incremental cost per QALY gained of $77,504 versus erlotinib.
