The K-GEM showed KRd is cost-effective, with an ICER of $107,520 per QALY gained against Rd for the treatment of patients with RMM (1-3 prior therapies) at a willingness-to-pay threshold of $150,000. Reimbursement of KRd for patients with RMM may represent an efficient allocation of the healthcare budget.

Kd56 is cost-effective for patients with R/RMM at a willingness-to-pay threshold of $150,000/QALY. Trial data in the model may limit generalizability; however, SEER registry data mitigates this challenge. Kd56 provides additional value in key subgroups, and remains cost-effective after steep comparator discounts.

Aims: Although the benefit of first-line epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) over chemotherapy in EGFR mutation-positive (EGFRm) non-smallcell lung cancer (NSCLC) has been demonstrated in clinical trials, the optimal treatment sequence remains unclear. The objective of our study was to evaluate the cost-effectiveness of dacomitinib in Sweden versus afatinib and osimertinib in first-line treatment of EGFRm NSCLC. Materials and methods: A partitioned survival model was developed with three health states: progression-free, post-progression, and death. Progression-free and overall survival curves were used to inform movements between states. Clinical data were taken from randomized trials, compared via a network meta-analysis (NMA). Utility data were taken from published studies and costs from national Swedish sources. The model used a 15-year time horizon and a Swedish healthcare payer perspective. Sensitivity and scenario analyses were performed. Results: The base-case analysis showed that dacomitinib accrued a total of 2.10 qualityadjusted life years (QALYs) at a total cost of Swedish krona (SEK) 874,615. The incremental cost-effectiveness ratio (ICER) for dacomitinib versus afatinib was SEK 461,556 per QALY gained. The ICER of osimertinib versus dacomitinib, where the small QALY gains of the former came at a high additional cost, was SEK 11,444,709. Deterministic and probabilistic sensitivity analyses confirmed robustness of these results; changes to drug and medical resource use costs and overall survival had the greatest impact on ICER estimates. Limitations: This model is subject to uncertainty associated with extrapolating long-term A c c e p t e d M a n u s c r i p t treatment effects from shorter trial follow-up periods, although this would also be a limitation when using direct comparison or time-dependent hazard ratios. The NMA was limited by the use of indirect comparison although sensitivity analyses supported the robustness of our findings. Conclusions: Our model demonstrated dacomitinib is cost-effective for first-line EGFRm NSCLC treatment in Sweden versus afatinib and osimertinib.

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