Cost-Effectiveness of Adjuvant Osimertinib for Resected EGFR-Mutant NSCLC

Findings from a cost-effectiveness analysis demonstrate that there is significant cost associated with the use of 3 years of adjuvant osimertinib for patients with resected EGFR-mutant NSCLC (Oncologist. 2022;oyac021. doi:10.1093/oncolo/oyac021).

“The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor osimertinib was recently approved for resected EGFR-mutant stages IB-IIIA [NSCLC] due to improved disease-free survival (DFS) in this population compared with placebo,” explained Christopher Lemmon, MD, Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Ohio, and colleagues.

This study aimed to evaluate the cost-effectiveness of osimertinib for this patient population.

To compare cost and quality-adjusted life years (QALYs) of 3 years of adjuvant osimertinib vs placebo over a 10-year time horizon, Dr Lemmon and colleagues developed a Markov model using post-resection health state transitions with digitized DFS data from the ADAURA trial.

The model assumed an overall survival (OS) benefit of 5%. Medicare reimbursement data and literature were used to collect cost and utility values and a cost-effectiveness threshold of 3 times the gross domestic product per capita was used.

The incremental cost-effectiveness ratio (ICER) for adjuvant osimertinib was $317,119 per QALY gained vs placebo. The study found that Initial costs of osimertinib are higher in years 1-3, but costs due to progressive disease are higher in the placebo group through the first 6.5 years.

In the placebo group, the average pre-progressive disease costs were $2388, post-progressive disease costs were $379,047, and total costs were $502,937. For the osimertinib group, these were $505,775, $255,638, and $800,697, respectively.

Sensitivity analysis of OS gains revealed osimertinib reaches cost-effectiveness with a hazard ratio of 0.70-0.75 benefit over placebo. Dr Lemmon and colleagues determined that a 50% discount to the cost of osimertinib would yield an ICER of $115,419.

“Our model demonstrates that there is significant cost associated with the use of 3 years of adjuvant osimertinib, with the majority due to associated drug cost, limiting the cost-effectiveness of this strategy,” wrote Dr Lemmon and colleagues.

“However, a hypothetical OS benefit of osimertinib of 25%-30% over placebo would improve the ICER to meet a prespecified cost-effectiveness threshold of $195,000,” they added.