Cost effectiveness analysis of afatinib versus pemetrexed-cisplatin for first-line treatment of locally advanced or metastatic EGFR mutation positive non-small-cell lung cancer from the Singapore healthcare payer’s perspective

Table 4 Unit costs included in the model

	Cost (SG$)	Range (SG$)	Source
Cost of drugs^a
Afatinib (per 40 mg tablet)^b	102.95	98.80 to 104.29	[f]
Pemetrexed (per 500 mg vial)^b	440.54	327.80 to 562.30	[f]
Cisplatin (per 50 mg vial)^b	15.61	12.45 to 18.50	[f]
Cost of chemotherapy administration
Facility fee/chair time (2 to 4 h)^c	272.20	241.00 to 319.00	[f]
Chemotherapy preparation fee by pharmacy	52.80	12.00 to 80.00	[f]
Cost of consultation visit and monitoring
Consultation visit	74.57	93.00 to 102.72	[f]
Computerised tomography-thorax scan	940.00	850.00 to 1000.00	[f]
Liver function test	71.30	52.40 to 83.90	[f]
Full blood count test	26.46	24.00 to 28.10	[f]
Renal panel test	62.80	35.20 to 81.20	[f]
Cost of best supportive care (BSC)
Inpatient hospice stay (per day)	275.00	–	[g]
Home hospice visit	Nil^d	–	[g]
Cost of managing adverse event
Anaemia (per episode)^e	1486.00	–	[h]
Diarrhoea (per episode)^e	1382.40	–	[h]

^aCost of drug is based on the selling price to patient
^bDosing regimens were based on recommended dosages in package inserts for afatinib (40 mg/day), pemetrexed (500 mg/m²/cycle) and cisplatin (75 mg/m²/cycle) and assumed no vial sharing. Up to 6 cycles of chemotherapy, every 21 days, were allowed. An average Body Surface Area (BSA) of 1.6m² was assumed
^cChair time for chemotherapy is approximately 2 h and 40 min. Pemetrexed is infused over 10 min, followed by 30 min break before infusion of cisplatin over 2 h approximately
^dHome hospice visit is complementary from the hospice centre
^eIncluded hospital admission charges and treatment cost
Source: ^f weighted average selling price across public healthcare institutions in Singapore; ^g price charged by one hospice centre in Singapore; ^h inpatient bill sizes [18, 19]

ISSN: 1471-2407