Cost-Effectiveness of Osimertinib in Treating Newly Diagnosed, Advanced EGFR-Mutation-Positive Non-Small Cell Lung Cancer

Background: The objective of this study was to assess cost and effectiveness of osimertinib in treating newly diagnosed advanced non-small cell lung cancer with an epidermal growth factor receptor (EGFR) mutation from a public payer's perspective in the U.S. and China.

Materials and methods: Markov models were developed to compare three treatment strategies: first-line use of osimertinib, first-line use of the standard first-generation EGFR-tyrosine kinase inhibitor (EGFR-TKI) followed by the second-line use of osimertinib, and the standard first-generation EGFR-TKI therapy (standard care [SOC]). Clinical data, cost, and utility data were mainly derived from published literatures. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the incremental cost per quality-adjusted life year (QALY) between the treatments.

Results: The resultant incremental cost per QALY gained for the first-line osimertinib versus SOC was $312,903 in the U.S. and $41,512 in China. The incremental cost per QALY for the second-line osimertinib versus SOC was $284,532 in the U.S. and $38,860 in China. The probability of the SOC strategy being cost-effective is 1.0 if the willingness to pay threshold is below $150,000/QALY in the U.S. and below $30,000/QALY in China.

Conclusion: Osimertinib as first-line treatment could gain more health benefits in comparison with standard EGFR-TKIs or second-line use of osimertinib. However, because of the high cost of treatment, the cost-effectiveness analyses were not in favor of the first-line use of osimertinib from a public payer's perspective in the U.S. and China.

Implications for practice: Osimertinib as first-line treatment yielded the greatest health outcomes but is not a cost-effective strategy for lung cancer in the U.S. and China. The price of osimertinib has a substantial impact on economic outcomes.