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Ruxu You,1,* Jinyu Liu,2,* David Bin-Chia Wu,3 XinYu Qian,4 Boxiang Lyu,5 Yu Zhang,1 Nan Luo4 1Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 2Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 3School of Pharmacy, Monash University Malaysia, Kuala Selangor, Malaysia; 4Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; 5Machine Learning Department, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA*These authors contributed equally to this workCorrespondence: Nan LuoSaw Swee Hock School of Public Health, National University of Singapore, 16 Medical Drive, Block MD3, Singapore 117597, SingaporeTel +65 6516 4966 Ext 188Fax +65 6779 1489Email ephln@nus.edu.sgObjective: The purpose of this study was to evaluate the cost-effectiveness of the combined use of afatinib and epidermal growth factor receptor (EGFR) testing versus gemcitabine-cisplatin as the first-line treatment for patients with non-small cell lung cancer (NSCLC) in China.Methods: A decision-analytic model, based on clinical phase III trials, was developed to simulate patient transitions. Direct costs were estimated from the perspective of the Chinese healthcare system. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER) were calculated over a 5-year lifetime horizon. Model robustness was conducted in sensitivity analyses.Results: For the base case, EGFR mutation testing followed by afatinib treatment for advanced NSCLC increased 0.15 QALYs compared with standard chemotherapy at an additional cost of $5069.12. The ICER for afatinib maintenance was $33,416.39 per QALY gained. The utility of PFS and the cost of afatinib had the most important impact on the ICER. Scenario analyses suggested that when a patient assistance program (PAP) was available, ICER decreased to $22,972.52/QALY lower than the willingness-to-pay (WTP) threshold of China ($26,508/QALY).Conclusion: Our results suggest that gene-guided maintenance therapy with afatinib with the PAP might be a cost-effective treatment option compared with gemcitabine – cisplatin in China.Keywords: Economic analysis, incremental cost-effectiveness ratio, NSCLC, EGER mutation testing, Afatinib

Li Shean Toh,1 Pauline Siew Mei Lai,2 David Bin-Chia Wu,3 Kok Thong Wong,1 Bee Yean Low,1 Alexander Tong Boon Tan,4 Claire Anderson5 1School of Pharmacy, University of Nottingham, Semenyih, Malaysia; 2Department of Primary Care Medicine, University of Malaya Primary Care Research Group, University of Malaya, Kuala Lumpur, Malaysia; 3School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia; 4Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 5Division of Social Research in Medicine and Health, School of Pharmacy, University of Nottingham, Nottingham, UK Purpose: To develop and validate the English version of the Satisfaction Questionnaire for Osteoporosis Prevention (SQOP) in Malaysia.Methods: The SQOP was modified from the Osteoporosis Patient Satisfaction Questionnaire and developed based on literature review and patient interviews. Face and content validity were established via an expert panel. The SQOP consists of two sections: clinical services and types of counseling. There were 23 items in total, each with a five-point Likert-type response. Satisfaction score was calculated by converting the total score to a percentage. A higher score indicates higher satisfaction. English speaking, non-osteoporotic, postmenopausal women aged ≥50 years were included in the study. Participants were randomized to either the control or intervention group. Intervention participants were provided counseling, whereas control participants received none. Participants answered the SQOP at baseline and 2 weeks later.Results: A total of 140 participants were recruited (control group: n=70; intervention group: n=70). No significant differences were found in any demographic aspects. Exploratory factor analysis extracted seven domains. Cronbach’s a for the domains ranged from 0.531–0.812. All 23 items were highly correlated using Spearman’s correlation coefficient 0.469–0.996 (P