A.W. Pohlman3, A. Vasilopoulos1, K.R. Shen2, A.M. Odeh3, Z. Abdelsattar3 1Loyola University Chicago Stritch School Of Medicine, Maywood, IL, USA 2Mayo Clinic, Thoracic Surgery, Rochester, MN, USA 3Loyola University Medical Center, Thoracic And Cardiovascular Surgery, Maywood, IL, USA
Introduction:
Osimertinib is now approved as targeted adjuvant therapy for resected stage IB-III non-small cell lung cancer (NSCLC) patients whose tumors have epidermal growth factor (EGFR) exon 19 deletions or exon 21 L858R mutations. However, the cost of Osimertinib is at least $12,750/month and must be taken for 3 years. Patients are commonly treated with combination osimertinib and chemotherapy with questionable utility. In this context, we investigate the cost-effectiveness of adjuvant Osimertinib with and without chemotherapy for resected NSCLC.
Methods:
A set of Markov models was established to predict the cost-effectiveness of Osimertinib with chemotherapy (Cisplatin-Pemetrexed) vs. Osimertinib alone vs. Cisplatin-Pemetrexed alone. Data were sourced from the ADAURA trial's publications and protocols. Health outcomes were quantified as quality-adjusted life-years (QALY). Costs and incremental cost-effectiveness ratios (ICERs) were estimated in USD and USD/QALY, respectively. Deterministic and probabilistic sensitivity analyses were performed.
Results:
Compared to treatment with Cisplatin-Pemetrexed alone, treatment with Osimertinib plus chemotherapy yielded, per patient, 5.37 QALYs with incremental cost 434,745.88 USD (ICER = 259,346.61 USD/QALY). Treatment with Osimertinib alone yielded, per patient, 6.68 QALYs with incremental cost 422,454.11 USD (ICER = 138,877.894 USD/QALY). Osimertinib is only likely to be cost-effective if the willingness to pay threshold per QALY is $200,000 or more (Figure). The price of Osimertinib was associated with the strongest influence on cost-effectiveness.
Conclusion:
Compared to treatment with Cisplatin-Pemetrexed, Osimertinib with chemotherapy is very unlikely to be cost-effective for treatment of resected NSCLC. Osimertinib alone is more likely to be cost-effective than combined therapy but only if the willingness to pay threshold is high. A reduction in the price of Osimertinib would improve its cost-effectiveness. However, it is important to note that the utility of combined chemotherapy-osimertinib treatment outside of a cost-effectiveness viewpoint should be decided between a physician and their patient based on the most recent and patient-specific data.