2SPD-005 Economic analysis of osimertinib in previously untreated EGFR mutant advanced non-small cell lung cancer

Critical Examination of Modeling Approaches Used in Economic Evaluations of First-Line Treatments for Locally Advanced or Metastatic Non-Small Cell Lung Cancer Harboring Epidermal Growth Factor Receptor Mutations: A Systematic Literature Review

“…For the remainder, studies stated that the use was for policy/funding decisions ( n = 5) [ 34 , 35 , 48 , 56 , 62 ], to promote the sustainability of limited healthcare resources ( n = 5) [ 30 – 32 , 60 , 61 ], or to support treatment choices ( n = 7) [ 39 , 47 , 50 , 55 , 57 , 59 , 65 ]. Twenty-two studies did not explicitly state the intended use of the economic evaluations [ 33 , 36 – 38 , 40 – 46 , 49 , 51 – 54 , 58 , 63 , 64 , 66 – 68 ].…”

“…All 59 studies included an EGFR TKI as an intervention; this was considered appropriate given the focus of the identified studies in patients harboring an EGFR mutation. The most frequently evaluated interventions were osimertinib ( n = 18) [ 30 , 32 , 34 , 35 , 38 , 40 , 44 , 47 , 50 , 51 , 55 , 62 , 68 , 71 , 73 , 78 , 83 , 88 ], dacomitinib ( n = 14) [ 31 , 32 , 40 , 42 , 43 , 47 , 52 , 53 , 63 , 67 , 72 , 74 , 82 , 87 ], afatinib ( n = 17) [ 32 , 33 , 36 , 39 , 40 , 45 , 46 , 56 , 57 , 59 , 65 , 66 , 69 , 70 , 77 , 80 , 86 ], gefitinib ( n = 12) [ 33 , 37 , 40 , 41 , 49 , 50 , 54 , 65 , 69 , 75 , 81 , 84 ], and erlotinib ( n = 12) [ 32 , 40 , 50 , ...…”

“…The most common comparators among the 59 studies reporting on an economic evaluation in locally advanced NSCLC patients harboring an EGFR mutation were EGFR TKIs ( n = 35) [ 30 – 32 , 34 – 36 , 38 , 41 – 45 , 48 , 51 – 55 , 59 , 61 , 63 , 67 , 68 , 71 – 74 , 78 , 80 , 82 , 83 , 85 – 88 ], platinum-based chemotherapy ( n = 12) [ 49 , 56 , 58 , 60 , 65 , 66 , 75 – 77 , 79 , 81 , 84 ], or either EGFR TKIs or platinum-based chemotherapies evaluated in the same model ( n = 5) [ 37 , 39 , 57 , 62 , 70 ]. Seven studies did not distinguish a reference comparator but evaluated multiple first-line treatments [ 33 , 40 , 46 , 47 , 50 , 64 , 69 ].…”

“…Twenty-eight studies did not state the rationale for the choice of comparator [ 30 , 33 , 35 , 36 , 38 , 39 , 41 – 43 , 45 , 46 , 48 , 52 , 54 , 56 – 63 , 65 – 68 , 72 , 76 ]. In the remaining 31 studies, comparators were selected to reflect standard of care, which was defined as commonly used regimens or licensed treatment [ 31 , 32 , 34 , 37 , 40 , 44 , 47 , 49 – 51 , 53 , 55 , 64 , 69 – 71 , 73 – 75 , 77 – 88 ]. Only one of these studies also included comparator regimens that were investigational in order to provide a comprehensive picture of possible treatment options [ 40 ].…”

“…Most were cost-utility analyses ( n = 52) [ 30 – 32 , 34 – 44 , 46 – 50 , 52 , 53 , 55 – 79 , 81 – 95 ], four were cost-effectiveness analyses [ 33 , 45 , 51 , 54 ], one was a cost-minimization analysis [ 80 ], and two (both of which were HTA submissions) presented both a cost-utility and cost-minimization analysis depending on the comparator [ 76 , 81 ]. The choice of model type was only reported in two studies that used a cost-minimization analysis, to justify that model type, given there were no statistically significant differences in efficacy and safety between treatment options [ 80 , 81 ].…”