Cost-effectiveness of osimertinib in the UK for advanced EGFR-T790M non-small cell lung cancer

Bertranou, Evelina; Bodnar, Carolyn; Dansk, Viktor; Greystoke, Alastair; Large, Samuel; Dyer, Matthew

doi:10.1080/13696998.2017.1377718

Cited by 32 publications

(27 citation statements)

References 18 publications

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“…inhibitors for first-line treatment of NSCLC patients with EGFR mutations [42,43] or ALK translocations [44]. However, the present study had several limitations due to data availability and assumptions made at the time of the analysis.…”

Section: Discussionmentioning

confidence: 96%

Cost-effectiveness analysis of pembrolizumab versus standard-of-care chemotherapy for first-line treatment of PD-L1 positive (>50%) metastatic squamous and non-squamous non-small cell lung cancer in France

Chouaïd¹,

Bensimon²,

Clay³

et al. 2019

Lung Cancer

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In the KEYNOTE-024 trial, pembrolizumab demonstrated significant improvements in progressionfree survival (PFS) and overall survival (OS) versus Standard-of-Care (SoC) platinum-based doublets for first-line treatment of PD-L1-positive (≥50%) metastatic Non-Small-Cell Lung Cancer (NSCLC) patients with no EGFR mutations or ALK translocations. This study aims to assess the cost-effectiveness of pembrolizumab versus SoC platinum-based chemotherapy from the French healthcare system perspective. Methods: A three-state partitioned-survival model was adapted to project outcomes and costs of squamous and non-squamous NSCLC patients respectively, over a 10-year time horizon. Clinical and utility data were collected from the trial. A network meta-analysis was performed to consider platinum-based triplets also used for nonsquamous NSCLC. Direct medical costs were considered based on ressources identified from the trial and literature. Costs and outcomes were discounted at 4% per year. Incremental cost-effectiveness ratios (ICERs) were calculated as cost per Life Year (LY) and cost per Quality-Adjusted Life Year (QALY). Sensitivity and scenario analyses were performed to assess the robustness of results. Results: For squamous NSCLC, pembrolizumab was projected to increase life expectancy of patients by 0.93 LY (11 months), and 0.74 QALY (9 months) for an incremental cost of €62,032 compared with platinum-based doublets. The ICER of pembrolizumab versus platinum-based doublets was €66,825/LY and €84,097/QALY. For non-squamous NSCLC, pembrolizumab was projected to increase life expectancy of patients by 0.85-1.32 LYs (10.2-15.8 months) and 0.64-1.02 QALYs (7.7-12.2 months) for an incremental cost varying from €-14,947-+47,064 depending on the specific comparator. The ICER of pembrolizumab versus platinum-based chemotherapy with paclitaxel plus bevacizumab was €62,846/LY and €78,729/QALY; regimens including pemetrexed were dominated. Results were most sensitive to extrapolations of survival outcomes and assumptions for continued effectiveness and treatment duration of pembrolizumab. Conclusions: Pembrolizumab appears cost-effective versus SoC chemotherapy for first-line treatment of PD-L1positive (50%) metastatic NSCLC patients in France, assuming willingness-to-pay under 100,000€/QALY (OECD threshold in the discussion section). prognosis of lung cancer is generally poor with a 5-year overall survival rate estimated at 10-15% worldwide [2]. In France, 5-year and 10-year survivals rates were 17% and 10% in 2015, respectively [3]. The poor prognosis of lung cancer can be explained by a diagnosis at an advanced stage of the disease. In 2012, about 1.6 million deaths due to lung

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Section: Discussionmentioning

confidence: 96%

Cost-effectiveness analysis of pembrolizumab versus standard-of-care chemotherapy for first-line treatment of PD-L1 positive (>50%) metastatic squamous and non-squamous non-small cell lung cancer in France

Chouaïd¹,

Bensimon²,

Clay³

et al. 2019

Lung Cancer

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“…Given that the clinical evidence on the first‐line use of osimertinib is relatively new, its cost‐effectiveness evidence is rather limited. There are only two published economic evaluations for osimertinib, both conducted in second‐line settings . A model‐based cost utility analysis was conducted in the U.K. to compare the second‐line use of osimertinib with platinum‐based doublet chemotherapy in treating patients with advanced NSCLC with EGFR‐T790 M mutation over a 15‐year time horizon .…”

Section: Discussionmentioning

confidence: 99%

“…There are only two published economic evaluations for osimertinib, both conducted in second‐line settings . A model‐based cost utility analysis was conducted in the U.K. to compare the second‐line use of osimertinib with platinum‐based doublet chemotherapy in treating patients with advanced NSCLC with EGFR‐T790 M mutation over a 15‐year time horizon . This study used phase II AURA trials as the main source for clinical inputs and found that the QALY gain was 1.541 at an incremental cost of £64,283, with the ICER of £41,705.…”

Section: Discussionmentioning

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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“…We used the 2018 US wholesale acquisition cost (WAC) of osimertinib for a 30-day prescription, which was $14,616 12 . The corresponding price point was £5,770 in the UK and CA$8,974 in Canada 13,14 . The 2018 average exchange rates coefficients were 0.78 from the USD to the GBP and 1.30 from USD to CAD conversion 7 .…”

Section: Model Inputsmentioning

confidence: 99%

Pricing methods in outcome-based contracting: δ3: reference-based pricing

Alkhatib

Erstad

Ramos

et al. 2020

Journal of Medical Economics

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Aims: Six Delta is a six-dimensional independent platform for outcome-based pricing/contracting. The third dimension (d3) estimates prices on the basis of international drug price referencing methods. We describe this dimension's methodology and present a proof-of-concept application to the treatment of non-small cell lung cancer (NSCLC) with EGFR mutation with osimertinib. Materials and methods: The reference-based pricing dimension utilizes a six-step method: (1) selecting foreign countries based on a set of four criteria (drug is available in the foreign country, price information is available in the foreign country, foreign countries are members within the organization for Economic Cooperation and Development, pricing methods in the foreign countries involve value assessment); (2) adjusting for exchange rates; (3) generating reference price (RP) scenarios; (4) adjusting with the medical inflation rate; (5) pooling all generated RP scenarios and calculating average and standard deviation (SD); (6) and Monte Carlo Simulation (MCS) to estimate the dimension-specific DSP Reference. A proof-of-concept exercise with osimertinib in NSCLC was performed for two hypothetical outcome-based contracts: 1-year (2019-2020) and 2-year (2019-2021). Results: The United Kingdom and Canada met the four criteria. For the osimertinib 1-year contract price, the average of eight RP scenarios, adjusted for inflation by 0.

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Cost-effectiveness of osimertinib in the UK for advanced EGFR-T790M non-small cell lung cancer

Cited by 32 publications

References 18 publications

Cost-effectiveness analysis of pembrolizumab versus standard-of-care chemotherapy for first-line treatment of PD-L1 positive (>50%) metastatic squamous and non-squamous non-small cell lung cancer in France

Cost-effectiveness analysis of pembrolizumab versus standard-of-care chemotherapy for first-line treatment of PD-L1 positive (>50%) metastatic squamous and non-squamous non-small cell lung cancer in France

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

Pricing methods in outcome-based contracting: δ3: reference-based pricing

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