Evaluation of Cost-Effectiveness of Adjuvant Osimertinib in Patients with Resected EGFR Mutation-Positive Non-small Cell Lung Cancer

Verhoek, Andre; Cheema, Parneet K.; Melosky, Barbara; Samson, Benoit; Shepherd, Frances A.; Marinis, Filippo de; John, Thomas; Wu, Yi‐Long; Heeg, Bart; Dalfsen, Nadia Van; Bracke, Benjamin; Miranda, Miguel; Shaw, S. E.; Moldaver, Daniel

doi:10.1007/s41669-023-00396-0

Cited by 4 publications

(2 citation statements)

References 34 publications

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“…Prior models have evaluated the cost-effectiveness of adjuvant osimertinib for individuals with EGFR-mutant resected NSCLC compared with placebo ( Lemmon et al, 2022 ; Zhou et al, 2022 ; Verhoek et al, 2023 ). However, the cost-effectiveness analysis was based on the OS data extracted from AURA3 and FLAURA clinical trials, which were conducted in advanced NSCLC.…”

Section: Discussionmentioning

confidence: 99%

Osimertinib in the treatment of resected EGFR-mutated non-small cell lung cancer: a cost-effectiveness analysis in the United States

Huo,

Song,

Liu

et al. 2024

Front. Pharmacol.

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Background: In the double-blind phase III ADAURA randomized clinical trial, adjuvant osimertinib showed a substantial overall survival benefit in patients with stage IB to IIIA, EGFR-mutated, completely resected non-small cell lung cancer (NSCLC). We conduct a cost-effectiveness analysis comparing the use of adjuvant osimertinib to placebo in patients with stage IB to IIIA, EGFR-mutated, resected NSCLC.Methods: Based on the results obtained from the ADAURA trial, a Markov model with three-state was employed to simulate patients who were administered either osimertinib or placebo until disease recurrence or completion of the study period (3 years). Quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratio (ICER) were calculated with a willingness-to-pay (WTP) threshold of $150,000 per QALY. Both univariate and probabilistic sensitivity analyses were carried out to explore the robustness of the model.Results: Osimertinib produced additional 1.59 QALYs with additional costs of $492,710 compared to placebo, giving rise to ICERs of $309,962.66/QALY. The results of the univariate sensitivity analysis indicated that the utility of disease-free survival (DFS), cost of osimertinib, and discount rate had the greatest impact on the outcomes. Probabilistic sensitivity analysis showed that osimertinib exhibited a 0% chance of being considered cost-effective for patients using a WTP threshold $150,000/QALY.Conclusion: In our model, osimertinib was unlikely to be cost-effective compared to placebo for stage IB to IIIA, EGFR-mutated, completely resected NSCLC patients from the perspective of a U.S. payer at a WTP threshold of $150,000 per QALY.

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Section: Discussionmentioning

confidence: 99%

Osimertinib in the treatment of resected EGFR-mutated non-small cell lung cancer: a cost-effectiveness analysis in the United States

Huo,

Song,

Liu

et al. 2024

Front. Pharmacol.

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“…As depicted in Supplementary Fig. 1, until year 10, the overall survival probabilities for both treatment arms were less than one percent, indicating a close approximation to a lifetime follow-up [ 11 ]. Health outcomes and direct medical costs are discounted annually at a rate of 3%.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of ivosidenib versus chemotherapy for previously treated IDH1-mutant advanced intrahepatic cholangiocarcinoma in Taiwan

Chen,

Huang,

Chen

et al. 2024

BMC Cancer

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Background International guidelines recommend ivosidenib followed by modified FOLFOX (mFOLFOX) for advanced intrahepatic cholangiocarcinoma (ICC) with isocitrate dehydrogenase 1 (IDH1) mutations. Taiwan National Health Insurance covers only fluorouracil/leucovorin (5-FU/LV) chemotherapy for this ICC group, and there has been no prior economic evaluation of ivosidenib. Therefore, we aimed to assess ivosidenib’s cost-effectiveness in previously treated, advanced ICC-presenting IDH1 mutations compared with mFOLFOX or 5-FU/LV. Methods A 3-state partitioned survival model was employed to assess ivosidenib’s cost-effectiveness over a 10-year horizon with a 3% discount rate, setting the willingness-to-pay threshold at 3 times the 2022 GDP per capita. Efficacy data for Ivosidenib, mFOLFOX, and 5-FU/LV were sourced from the ClarIDHy, ABC06, and NIFTY trials, respectively. Ivosidenib’s cost was assumed to be NT$10,402/500 mg. Primary outcomes included incremental cost-effectiveness ratios (ICERs) and net monetary benefit. Deterministic sensitivity analyses (DSA) and probabilistic sensitivity analyses (PSA) were employed to evaluate uncertainty and explore price reduction scenarios. Results Ivosidenib exhibited ICERs of NT$6,268,528 and NT$5,670,555 compared with mFOLFOX and 5-FU/LV, respectively, both exceeding the established threshold. PSA revealed that ivosidenib was unlikely to be cost-effective, except when it was reduced to NT$4,161 and NT$5,201/500 mg when compared with mFOLFOX and 5-FU/LV, respectively. DSA underscored the significant influence of ivosidenib’s cost and utility values on estimate uncertainty. Conclusions At NT$10,402/500 mg, ivosidenib was not cost-effective for IDH1-mutant ICC patients compared with mFOLFOX or 5-FU/LV, indicating that a 50–60% price reduction is necessary for ivosidenib to be cost-effective in this patient group.

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Cost-effectiveness of adjuvant icotinib versus chemotherapy for patients with stage II–IIIA EGFR-mutated non-small cell lung cancer in China

Mu,

Liu,

Fang

et al. 2024

BMJ Open

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ObjectiveIcotinib has been approved for adjuvant treatment of stage II–IIIA non-small cell lung cancer (NSCLC) patients with activating epidermal growth factor receptor (EGFR) mutations in China, yet the long-term costs and outcomes of this strategy are unknown. Thus, we examined the cost effectiveness of adjuvant icotinib, compared with adjuvant chemotherapy, for the treatment of resected stage II–IIIA EGFR-mutated NSCLC.DesignWe performed a cost-effectiveness analysis from the perspective of the Chinese healthcare system, comparing 2-year adjuvant icotinib with four cycles of adjuvant chemotherapy. Costs and quality-adjusted life years (QALYs) were estimated using a Markov model. Model inputs were obtained from local data and literature. The influence of model parameters and assumptions was explored in sensitivity analyses. All costs are expressed in 2022 US dollars, and costs and QALYs were discounted at a rate of 5% per year. The willingness-to-pay (WTP) threshold was set at three times the per capita gross domestic product.SettingThe Chinese healthcare system perspective.ParticipantsA hypothetical Chinese cohort of patients with resected stage II–IIIA EGFR-mutated NSCLC.InterventionsIcotinib versus chemotherapy.Primary outcome measureCosts, QALYs, incremental cost-effectiveness ratio.ResultsThe incremental cost per QALY gained with the use of 2-year icotinib, from the Chinese healthcare system perspective, was $3440.66 compared with adjuvant chemotherapy. At a WTP threshold of $40 500, adjuvant icotinib was the optimal treatment in over 99% of replications. The interpretation of the results was insensitive to model and input assumptions.ConclusionsCompared with adjuvant chemotherapy, adjuvant icotinib may be a cost-effective treatment for resected stage II–IIIA EGFR-mutated NSCLC as the WTP threshold is set at $40 500 per QALY.

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Evaluation of Cost-Effectiveness of Adjuvant Osimertinib in Patients with Resected EGFR Mutation-Positive Non-small Cell Lung Cancer

Cited by 4 publications

References 34 publications

Osimertinib in the treatment of resected EGFR-mutated non-small cell lung cancer: a cost-effectiveness analysis in the United States

Osimertinib in the treatment of resected EGFR-mutated non-small cell lung cancer: a cost-effectiveness analysis in the United States

Cost-effectiveness of ivosidenib versus chemotherapy for previously treated IDH1-mutant advanced intrahepatic cholangiocarcinoma in Taiwan

Cost-effectiveness of adjuvant icotinib versus chemotherapy for patients with stage II–IIIA EGFR-mutated non-small cell lung cancer in China

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