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吉非替尼、厄洛替尼、阿法替尼和奥希替尼已被推荐为表皮生长因子受体突变的晚期非小细胞肺癌的一线治疗药物,但同时比较这四种酪氨酸激酶抑制剂在中国的经济性目前尚无研究.本研究旨在评价吉非替尼、厄洛替尼、阿法替尼和奥希替尼一线治疗表皮生长因子受体突变的晚期非小细胞肺癌的成本-效果性.通过构建马尔科夫模型,从中国医疗系统角度评价四种酪氨酸激酶抑制剂对初治的表皮生长因子受体突变的晚期非小细胞肺癌患者的影响.临床数据和效用值来源于文献,成本来源于中国官方网站.主要结局指标为增量-成本效果比,通过敏感性分析检验模型的稳健性.研究发现阿法替尼治疗成本最低,生存获益最少;奥希替尼治疗成本最高,生存获益最大.与阿法替尼相比,吉非替尼每多获得一个质量调整生命年需多花费732美元,该数值低于29 382美元/每质量调整生命年的意愿支付阈值.与吉非替尼相比,厄洛替尼治疗成本更高但生存时间更短,因此被认为是劣势方案.奥希替尼与吉非替尼比较的增量-成本效果比为71 330美元/每质量调整生命年,超过意愿支付阈值.这表明,从中国医疗系统角度来看,吉非替尼是表皮生长因子受体突变晚期非小细胞肺癌一线治疗中性价比最高的方案.降低奥希替尼的价格或将意愿支付阂值提高到68 558美元/每质量调整生命年可能可以提高奥希替尼的经济性.单因素敏感性分析表明该模型是稳健的.“,”Gefitinib,erlotinib,afatinib and osimertinib have been recommended as the first-line treatment for epidermal growth factor receptor (EGFR)-mutated advanced non-small cell lung cancer (NSCLC),whereas no studies have compared the cost-effectiveness of these four tyrosine kinase inhibitors (TKIs) simultaneously in China.In the present study,we aimed to estimate the cost-effectiveness of erlotinib,gefitinib,afatinib and osimertinib for untreated EGFR-mutated advanced NSCLC.A Markov model was constructed to compare the 10-year impact of four TKIs for patients with treatment-naive EGFR-mutated advanced NSCLC from the perspective of the Chinese medical system.Clinical data and utility values were derived from published literature,and costs were obtained from Chinese official websites.The primary output indicator was the incremental cost-effectiveness ratio (ICER).Sensitivity analyses were performed to test the robustness of the model.We found that afatinib was estimated to spend the lowest cost with minimum life-years (LYs),while osimertinib was the most expensive regimen with maximum LYs.The ICER of gefitinib versus afatinib was $732/quality-adjusted life-year (QALY),which was less than the willingness-to-pay (WTP) of $29 382/QALY.Compared with gefitinib,erlotinib yielded a higher cost and a shorter lifetime,hence it was identified as a dominated strategy.Then,osimertinib was compared to gefitinib,which produced an ICER of $71 330/QALY,exceeding the WTP.It suggested that gefitinib was the most cost-effective regimen as the first-line treatment for EGFR-mutated advanced NSCLC.Decreasing the osimertinib price or increasing the WTP threshold to $68 558/QALY might enhance the favorability of the outcome,by which osimertinib might become more cost-effective.One-way sensitivity analysis manifested that the model was robust.