Cost-effectiveness of osimertinib versus standard EGFR-TKI as first-line treatment for EGFR-mutated advanced non-small-cell lung cancer in China

Abstract

Objective: The purpose of this study was to estimate the cost-effectiveness of osimertinib for the first-line treatment of patients with EGFR-mutated advanced non-small-cell lung cancer (NSCLC) from the perspective of the Chinese healthcare system.Methods: A Markov model was developed to simulate the outcomes and direct medical costs of osimertinib or standard EGFR-TKI in the first-line treatment of patients with previously untreated EGFR-mutated advanced NSCLC. Individual patient survival data were extracted from the FLAURA randomized clinical trial. Clinical costs and utilities’ input estimates were collected from the local hospital and available literature reports. The quality-adjusted life-year (QALY), incremental cost-effectiveness ratio (ICER), incremental net monetary benefit (INMB), and incremental net health benefit (INHB) were calculated for the two treatment strategies over a 10-year lifetime horizon. In addition, one-way sensitivity analysis, probabilistic sensitivity analysis, and subgroup analysis were performed to test the robustness of the model.Results: On baseline analysis, osimertinib achieved additional 0.39 QALYs and $15,443.78 incremental costs compared with standard EGFR-TKI (gefitinib or erlotinib), which resulted in the ICER of $39,369.53/QALY. The INMB was -$755.11, and the INHB was -0.02 QALYs at a WTP threshold of $37,663.26/QALY in China. The one-way sensitivity analysis showed that the utility of PFS had the strongest association with the ICER. Osimertinib had approximately 46.4% probability of being cost-effective at the WTP threshold of $37,663.26/QALY.Conclusion: First-line osimertinib therapy might not be cost-effective in China for patients with EGFR-mutated advanced NSCLC compared with standard EGFR-TKI based on its current marketed price. A significantly more favorable cost-effectiveness could be achieved when the price of osimertinib was reduced by 5%.

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

“…The results of the economic evaluations were used to directly support decisions regarding reimbursement via HTA documents (n = 20) [69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88]. 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].…”

“…Given the intended use and objectives of the economic evaluations identified, i.e., to make decisions at a single point in the disease pathway (locally advanced [stage IIIB/IIIC] 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,…”

“…A similar number of studies used a Markov model (n = 20) [30, 33, 38, 40, 41, 47, 50, 57-62, 65, 68, 71, 75, 77, 81, 84] or a partitioned survival model (n = 22) [31, 32, 34, 36, 42-44, 46, 52, 53, 56, 67, 69, 70, 72, 73, 78, 82, 83, 86-88]. For the remaining studies, seven used a decision tree and Markov model (n = 7) [35,39,48,49,55,63,66], six of which depicted a schematic decision tree, followed by the Markov state transition model [35,39,49,55,66]. Other model structures included semi-Markov (n = 2 [79,85]) or decision tree only (n = 1 [37]).…”

“…Patients who underwent testing and tested positive for an EGFR mutation would receive an EGFR TKI, while those testing negative would receive platinum-based chemotherapy [49,66]. Other studies that also adopted a decision tree used it as a basis for assigning different interventions to patients [35,39,48,55,63].…”

“…Sixteen studies applied a half-cycle correction in the model [31,32,34,38,41,48,55,56,58,73,77,[84][85][86][87][88]; however, the method utilized was only stated in HTA submissions for dacomitinib [87] and osimertinib [88], in which the number of patients at the start and end of each cycle was averaged for costs and outcomes. Time horizons modeled were 1 year (n = 2) [51, 80], 4 years (n = 1) [58], 5 years (n = 10) [44, 46, 56, 66, 70, 75-77, 79, 84], 7 years (n = 1) [72], 10 years (n = 20) [34-36, 38, 39, 49, 50, 55, 57, 59-63, 65, 67, 72, 78, 85, 86], 15 years (n = 8) [30-32, 42, 43, 53, 82, 87], and 20 years (n = 4) [68,73,83,88].…”