Cost-Effectiveness of Osimertinib for EGFR Mutation–Positive Non–Small Cell Lung Cancer after Progression following First-Line EGFR TKI Therapy

Wu, Bin; Gu, Xiang; Zhang, Qiang

doi:10.1016/j.jtho.2017.10.012

Cited by 57 publications

(49 citation statements)

References 33 publications

(56 reference statements)

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“…Because median OS has not yet been observed, only PFS data from the AURA3 and FLAURA trials were used. As our previous study showed, the OS data after the second‐line treatment were derived from the other study . By following the standard process , we digitized the Kaplan‐Meier survival curves reported in both trials and then fit Weibull and log‐logistic survival models to the replicated individual patient data.…”

Section: Methodsmentioning

confidence: 99%

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

Wu¹,

Zhang

et al. 2018

The Oncologist

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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.

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Section: Methodsmentioning

confidence: 99%

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

Wu¹,

Zhang

et al. 2018

The Oncologist

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“…All cost-effectiveness analyses that were conducted in the United States, as well as most other analyses, included costs related to adverse events (AEs) and, for drug acquisition costs, used publicly available and/or published prices (eg, wholesale acquisition costs); this also applies to analyses discussed in the subsequent section of this article on cost considerations in second-line therapy. In some US analyses, 37 , 38 drug acquisition costs were discounted (eg, by 17%) to account for contract prices.…”

Section: Use Of Egfr Tkis In the First-line Setting: Clinical Efficacmentioning

confidence: 99%

“…Wu et al analyzed data from the AURA3 study to investigate the costs associated with testing for T790M mutations in the plasma and tissue of patients who had disease progression despite first-line treatment with EGFR TKIs followed by second-line treatment with osimertinib or chemotherapy with cisplatin plus pemetrexed in the United States and in China. 38 The ICERs for osimertinib vs chemotherapy were $232,895 and $48,081 per QALY in the United States and China, respectively (year of costing, 2017). The researchers concluded that osimertinib treatment for T790M mutation–positive NSCLC is unlikely to be cost-effective in either country.…”

Section: Use Of Egfr Tkis In the First-line Setting: Clinical Efficacmentioning

confidence: 99%

Optimal sequencing strategies in the treatment of EGFR mutation–positive non–small cell lung cancer: Clinical benefits and cost-effectiveness

Hirsh

Singh

2020

American Journal of Health-System Pharmacy

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Purpose To summarize current understanding of the efficacy, role, and cost-effectiveness of the available epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), and to evaluate sequencing strategies based on the available evidence. Summary. EGFR TKIs are the current standard of care for patients with EGFR mutation–positive non–small cell lung cancer (NSCLC). Five EGFR TKIs are currently approved in the United States for use in a first-line setting; these TKIs differ in mechanism of action, efficacy, safety, and cost. Most patients develop resistance to first-line EGFR TKIs and require subsequent therapy with additional EGFR TKIs, chemotherapy, and/or other targeted agents. A major consideration when selecting EGFR TKIs, both as first-line or subsequent treatment options, is cost-effectiveness. Although clinical trials have shown that the second- and third-generation EGFR TKIs are superior in efficacy to the first-generation agents, pharmacoeconomic studies suggest that the first-generation agents are the most cost-effective, with the second-generation TKI afatinib also considered cost-effective in some studies. Despite its impressive efficacy, osimertinib appears to be less cost-effective due to substantially higher acquisition costs. Conclusion Preliminary data suggest that first-line afatinib followed by osimertinib may offer promising survival outcomes and, on the basis of efficacy alone, may represent an optimal sequencing strategy in the majority of patients with EGFR mutation–positive NSCLC, in particular Asian patients and those with Del19-positive tumors. However, considerably more research into outcomes and costs associated with consecutive sequencing of EGFR TKIs is needed before any conclusions can be reached.

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“…However, tumor recurrence or residual tumor during targeted therapy has been commonly reported and there is a lack of high‐level evidence on which type of treatment should be employed for these patients . Conventionally, alternative medical treatment or radiotherapy may be administrated as second‐ or third‐line therapy, although the effect is usually unpredictable and poor . On the other hand, there are some patients having had their NSCLC converted from an advanced to resectable stage as a result of targeted therapy, that salvage surgery may be another alternative option for tumor recurrence or residual tumor after targeted therapy …”

Section: Introductionmentioning

confidence: 99%

“…9,10 Conventionally, alternative medical treatment or radiotherapy may be administrated as second-or third-line therapy, although the effect is usually unpredictable and poor. [11][12][13] On the other hand, there are some patients having had their NSCLC converted from an advanced to resectable stage as a result of targeted therapy, that salvage surgery may be another alternative option for tumor recurrence or residual tumor after targeted therapy. 14 Salvage surgery already plays a role in the treatment of esophageal cancer, colorectal cancer and other tumors.…”

Section: Introductionmentioning

confidence: 99%

Salvage surgery for advanced non‐small cell lung cancer after targeted therapy: A case series

et al. 2020

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Background Tumor recurrence or residual tumor after targeted therapy is common in patients with advanced non‐small cell lung cancer (NSCLC). There is a lack of high‐level evidence on which type of treatment should be employed for these patients and the role of salvage surgery has not been well reported in the literature. Methods A retrospective analysis of patients who underwent salvage surgery in our center between January 2016 and June 2019 for advanced NSCLC after targeted therapy was performed. Results A total number of nine patients were identified, including five males and four females, with a median age of 56 years (range, 40–65 years), all diagnosed with lung adenocarcinoma stage IIIa–IVb. All patients had received targeted therapy according to individual positive mutation of driver gene(s). Salvage surgery was performed for tumor recurrence or residual tumor after a duration of 2–46 months of targeted therapy. A negative surgical margin was achieved in all cases. Postoperative complication rate was 11.1% (1/9). All patients were alive at the time of this analysis and two patients had disease progression. After a median follow‐up of 17 months (range: 5–44 months), the median event‐free survival and postoperative survival was 14 months (range: 2–44 months) and 17 months (range: 5–44 months) respectively. Conclusions Salvage surgery may be a feasible and promising therapeutic option for tumor recurrence or residual tumor in advanced NSCLC in selective patients after targeted therapy. Key points Salvage surgery is feasible in selected patients with advanced NSCLC and provides promising survival outcomes after targeted therapy failure. Salvage surgery provides precise molecular and pathological information which is most important for subsequent therapy.

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Cost-Effectiveness of Osimertinib for EGFR Mutation–Positive Non–Small Cell Lung Cancer after Progression following First-Line EGFR TKI Therapy

Abstract: Osimertinib treatment for T790M mutation NSCLC is unlikely to be cost-effective from the perspectives of the United States and the People's Republic of China. If the price of osimertinib could be decreased, the economic outcome might become favorable.

Cited by 57 publications

References 33 publications

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

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

Optimal sequencing strategies in the treatment of EGFR mutation–positive non–small cell lung cancer: Clinical benefits and cost-effectiveness

Salvage surgery for advanced non‐small cell lung cancer after targeted therapy: A case series

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