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

Ezeife, Doreen Anuli; Artanian, Veronica; Chew, Derek S.; Nixon, Nancy; Lee, Roy; Le, Lisa W.; Chan, Kelvin K.; Leighl, Natasha B.

doi:10.1016/j.lungcan.2018.08.024

Cited by 33 publications

(43 citation statements)

References 17 publications

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“…Our analysis showed that the model was most sensitive to the time horizon, albeit only to the lower variation of the parameter which was set at 5 years. Our base case time horizon was 10 years, which was consistent with other published CEAs [21][22][23] and also allowed for all QALYs to be fully captured. Shortening the time horizon to 5 years resulted in an increased ICER of SG$500,917.…”

Section: Discussionmentioning

confidence: 76%

“…Wu et al compared rst-line osimertinib with rst-generation EGFR TKIs (erlotinib and ge tinib) from a public payer's perspective in the U.S. and China and showed ICERs/QALY of US$327,601 and US$43,034 respectively [22]. The substantially lower ICER obtained for China was due to the reduced healthcare costs compared to the U.S. A cost-effectiveness study comparing rst-line osimertinib with ge tinib and afatinib from a public payer perspective in Canada obtained an ICER/QALY of $223,123 CAD [23]. Most of these CE studies, however, have used the OS and PFS curves from the interim analysis of FLAURA.…”

Section: Discussionmentioning

confidence: 99%

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Cost-effectiveness analysis of osimertinib for first-line treatment of locally advanced or metastatic EGFR mutation positive non-small cell lung cancer in Singapore

Aziz

Foo²,

Toh

et al. 2020

Preprint

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Background: Non-small cell lung cancer (NSCLC) accounts for the majority of all lung cancer cases and is usually associated with a poor prognosis. However, targeted therapy with 1st and 2nd generation tyrosine kinase inhibitors (TKIs) has so far improved progression-free survival of epidermal growth factor receptor (EGFR) mutant NSCLC patients. Osimertinib, a third generation EGFR TKI has recently shown improved overall survival in previously untreated EGFR mutant NSCLC patients. We assessed the cost-effectiveness of osimertinib versus standard EGFR TKIs (gefitinib or erlotinib) as first-line treatment for advanced or metastatic EGFR mutant NSCLC patients in Singapore. Methods: A partitioned survival model with three health states (progression-free, progressive disease, and death) was developed from the Singapore healthcare payer perspective. Survival curves from the FLAURA trial were extrapolated beyond trial period over a 10-year time horizon to estimate the underlying progression-free survival and overall survival parametric distributions. Health state utilities were derived from the literature and direct costs were sourced from public healthcare institutions in Singapore. Deterministic and probabilistic sensitivity analyses were conducted to explore the impact of uncertainties and assumptions on cost-effectiveness results. Results: Compared with 1st or 2nd generation TKI, osimertinib had a base-case incremental cost-effectiveness ratio (ICER) of SG$418,839 per quality-adjusted life year gained. One-way sensitivity analysis showed the ICER was most sensitive to time horizon and variations in progression-free utility values. Scenario analyses showed that a 50% reduction in the cost of osimertinib was still associated with a high ICER that was unlikely to be deemed cost effective. Conclusions: Osimertinib is not cost effective as a first-line treatment compared to standard EGFR TKIs in advanced EGFR mutant NSCLC patients in Singapore. The findings from our evaluation, alongside other considerations including the lack of survival benefit in the Asian subgroup of the FLAURA trial, will be useful to inform policy makers on funding decisions for NSCLC treatments in Singapore.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of osimertinib for first-line treatment of locally advanced or metastatic EGFR mutation positive non-small cell lung cancer in Singapore

Aziz

Foo²,

Toh

et al. 2020

Preprint

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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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“…Further cost-effectiveness analysis is necessary to confirm our cost and quality-of-life assessment comparison between first-line sequential treatment with afatinib versus first-line treatment with osimertinib. The cost-effectiveness of osimertinib has previously been evaluated in Canada [33], the United States and Brazil [34]. In the analysis conducted in Canada, first-line osimertinib therapy was compared to EGFR TKIs gefitinib and afatinib and was not considered as a cost-effective treatment option at a willingness-to-pay threshold of $100,000 per QALY [33].…”

Section: Discussionmentioning

confidence: 99%

“…The cost-effectiveness of osimertinib has previously been evaluated in Canada [33], the United States and Brazil [34]. In the analysis conducted in Canada, first-line osimertinib therapy was compared to EGFR TKIs gefitinib and afatinib and was not considered as a cost-effective treatment option at a willingness-to-pay threshold of $100,000 per QALY [33]. Similar results were reported in the United States and Brazil using World Health Organization cost-effectiveness threshold criteria; at current costs osimertinib was unlikely to be cost-effective in either the United States or Brazil [34].…”

Section: Discussionmentioning

confidence: 99%

Budget impact of sequential treatment with first-line afatinib versus first-line osimertinib in non-small-cell lung cancer patients with common EGFR mutations

Westerink

Nicolai

Samuelsen³

et al. 2020

Eur J Health Econ

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Background The therapeutic landscape for non-small-cell lung cancer (NSCLC) patients that have common epidermal growth factor receptor (EGFR) mutations has changed radically in the last decade. The availability of these treatment options has an economic impact, therefore a budget impact analysis was performed. Methods A budget impact analysis was conducted from a Dutch healthcare perspective over a 5-year time horizon in EGFR-mutant NSCLC patients receiving first-line afatinib (Gilotrif ®) versus first-line osimertinib (Tagrisso ®), followed by subsequent treatments. A decision analysis model was constructed in Excel. Scenario analyses and one-way sensitivity analysis were used to test the models' robustness. Results Sequential treatment with afatinib versus first-line treatment with osimertinib showed mean total time on treatment (ToT) of 29.1 months versus 24.7 months, quality-adjusted life months (QALMs) of 20.2 versus 17.4 with mean cost of €108,166 per patient versus €143,251 per patient, respectively. The 5-year total budget impact was €110.4 million for the afatinib sequence versus €158.6 million for the osimertinib sequence, leading to total incremental cost savings of €48.15 million. Conclusions First-line afatinib treatment in patients with EGFR-mutant NSCLC had a lower financial impact on the Dutch healthcare budget with a higher mean ToT and QALM compared to osimertinib sequential treatment.

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

Cited by 33 publications

References 17 publications

Cost-effectiveness analysis of osimertinib for first-line treatment of locally advanced or metastatic EGFR mutation positive non-small cell lung cancer in Singapore

Cost-effectiveness analysis of osimertinib for first-line treatment of locally advanced or metastatic EGFR mutation positive non-small cell lung cancer in Singapore

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

Budget impact of sequential treatment with first-line afatinib versus first-line osimertinib in non-small-cell lung cancer patients with common EGFR mutations

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