Model inputs: unit prices for resource use and summary of costs
| Costs Item | Estimated unit price (£) | Rash subgroup | Overall (£) | ||||
|---|---|---|---|---|---|---|---|
| Erlotinib (rash) (£) | Placebo/SC (£) | Difference (p value) (£) | Erlotinib | Placebo/SC | Difference | ||
| N=178 Mean (SE) | N=278 Mean (SE) | N=334 Mean (SE) | N=313 Mean (SE) | ||||
| Erlotinib* | 54.37/tablet | 7544 (764) | 0 | 7544 | 6863 (674) | 0 | 8074 |
| Supportive care: | |||||||
| Palliative RT† | 120/visit | 302 (52) | 235 (27) | 67 (p=0.0449) | 350 (48) | 242 (39) | 108 |
| Additional treatment‡ | See note c | 182 (65) | 270 (99) | −88 (p=0.85) | 190 (59) | 264 (76) | −74 |
| Patient management: | |||||||
| Hospital clinic visit§ | 100/visit | 629 (57) | 624 (53) | 5 (p=0.46) | 663 (49) | 654 (40) | 9 |
| Hospital day case§ | 670/day case | 274 (65) | 323 (131) | −49 (p=0.69) | 285 (71) | 356 (95) | −71 |
| Hospital admission§ | 730/night | 744 (163) | 475 (134) | 269 (p=0.0352) | 775 (149) | 534 (122) | 241 |
| Adverse events¶ | See note e | 221 (34) | 114 (27) | 107 (p<0.001) | 264 (40) | 181 (32) | 83 |
| Total mean cost (SE)** (95% CI) | 9949 (724) (8530 to 11 368 ) | 2058 (185) (1695 to 2420) | 7891 p<0.001) | 9210 (711) | 2121 (199) | 7089 | |
| Incremental Cost (SE)** | 7891 (614) (95% CI 6999 to 8783) | 7089 (589) (95% CI £5935 to £8243) | |||||
*Cost as £1631.53 for 30 tablets (150 mg tablet) or depending on dose; +Unit price based on national NHS tariff (NICE report 2011).7 ,9
†Palliative RT: Diagnosis and treatment of lung cancer update (2011).9
‡On the Placebo arm, 7 patients took additional chemotherapy (carboplatin/gemcitabine (n=5) erlotinib (n=2)) after progression; on the erlotinib arm, patients took carboplatin (n=2), vinorelbine (n=2), Fragmin (n=1).11 ,12
§Additional clinic visits and day visits irrespective of reason; unit prices taken from NHS reference costs 2010–2011; Hospital nights stayed as a result of treatment-related serious adverse events.13
¶Total costs for diarrhoea, rash and dyspnoea; duration of each AE was computed from the date of onset of the event to date resolved. Rash unit price taken from Lewis et al 201014; morphine dose of 15 mL/daily is about £0.22/day; steroid use (dexamethasone) based on £13.84 per 100 tablets and taking 3 tablets of 4–8 mg per day gives £0.42/daily dose; inhaler: salbutamol, £0.13/daily dose.15 Mean diarrhoea costs were £14 versus £2; mean rash costs were £68 versus £14.90 and mean dyspnoea costs were £139 versus £97.
**Determined using a generalised linear mixed model assuming gamma distributed costs for Erlotinib+Rash versus Placebo.NHS, National Health Service; NICE, National Institute for Health and Care Excellence; RT, radiotherapy.