Cost-effectiveness of lazertinib as first-line treatment in patients with EGFR-mutated advanced lung cancer

Background: Lazertinib demonstrates efficacy similar to that of osimertinib in the first-line treatment of epidermal growth factor receptor (EGFR)-mutated advanced lung cancer. However, its cost-effectiveness has not yet been evaluated.

Objective: To study the cost-effectiveness of lazertinib as a first-line treatment for patients with EGFR-mutated advanced lung cancer.

Design: A partitioned survival model-based cost-effectiveness analysis.

Methods: We conducted the economic analysis from the perspective of the healthcare sector with a lifetime horizon. Simulated patients were entered into the models upon the diagnosis of EGFR-mutated advanced lung cancer. Lazertinib was compared with gefitinib. The model inputs were derived from the trials (survival outcomes, incidence of adverse events (AEs), and subsequent therapies), National Health Insurance payments (costs of drugs and AEs), and hospital cohorts (utility values). Deterministic and probabilistic analyses were also conducted.

Results: Applying the same daily price of osimertinib (US$110) to that of lazertinib, the incremental cost-effectiveness ratio of lazertinib versus gefitinib was US$93,792 per quality-adjusted life year (QALY). The cost of lazertinib was a major determinant. If the daily price of lazertinib could be reduced to US$75, lazertinib would become cost-effective at a willingness-to-pay (WTP) threshold of US$70,000 per QALY. Given the WTP threshold, the probability that lazertinib would be cost-effective was 0.7%.

Conclusion: Lazertinib is not a cost-effective first-line treatment for EGFR-mutated advanced lung cancer. Lowering prices enables cost-effectiveness.