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Cost-effectiveness of Osimertinib as a Second-line Treatment in Patients With EGFR-mutated Advanced Non-Small Cell
Haijing Guan1, Gordon Liu2, Feng Xie3
1School of Pharmaceutical Sciences, Peking University, Beijing, China.
Purpose:
To assess the cost-effectiveness of osimertinib used as a second-line treatment after failure of epidermal growth factor receptor tyrosine kinase inhibitor therapy for advanced non-small cell lung cancer (NSCLC) in China.
Methods:
From the perspective of China's health care system, a Markov model was used for estimating the costs and health outcomes of osimertinib and 4 platinum-based chemotherapies, including pemetrexed + platinum (PP), gemcitabine + platinum (GP), docetaxel + platinum (DP), and paclitaxel + platinum (TP). Two scenarios were considered, one in all confirmed patients with T790M-positive disease (scenario 1) and the other in all patients whose disease progressed after epidermal growth factor receptor tyrosine kinase inhibitor therapy, which consisted of patients with T790M-positive or T790M-negative NSCLC (scenario 2). Clinical data for transition probabilities and treatment effects were obtained from published clinical trials. Health care resource utilization and costs were derived from local administrative databases and published literature. Deterministic and probabilistic sensitivity analyses were conducted to assess the uncertainty of the results.
Findings:
In the base-case analysis, compared with the 4 platinum-based chemotherapies, osimertinib yielded an additional 0.671 to 0.846 quality-adjusted life-year (QALY), with incremental costs of 15,943 to 20,299 USD in scenario 1, and an additional 0.376 to 0.808 QALY with incremental costs of 9710 to 15,407 USD in scenario 2. In the probabilistic sensitivity analysis, the probabilities that osimertinib would be cost-effective were 57.7% in scenario 1 and 58.4% in scenario 2 if the willingness-to-pay threshold were 30,000 USD/QALY, and probabilities would be more than 75 % in both scenarios if the willingness-to-pay threshold were 50,000 USD/QALY.
Implications:
Osimertinib is likely to be cost-effective when used as a second-line treatment of advanced NSCLC in China based on the latest reimbursement price of osimertinib through National Reimbursement Drug List negotiation.
Insights
Osimertinib is a cost-effective second-line treatment for advanced non-small cell lung cancer (NSCLC) in China. It offers improved quality-adjusted life-years (QALYs) compared to chemotherapy, justifying its price under national reimbursement.
Area of Science:
- Pharmacoeconomics
- Oncology
- Health Technology Assessment
Background:
- Advanced non-small cell lung cancer (NSCLC) treatment often involves sequential therapies.
- Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) are a standard first-line treatment for EGFR-mutated NSCLC.
- Treatment failure necessitates evaluating subsequent therapeutic options for improved patient outcomes and cost-effectiveness.
Purpose of the Study:
- To evaluate the cost-effectiveness of osimertinib as a second-line treatment for advanced NSCLC in China.
- To compare osimertinib with four platinum-based chemotherapy regimens.
- To assess cost-effectiveness under different clinical scenarios and willingness-to-pay thresholds.
Main Methods:
- A Markov model was developed from the perspective of China's healthcare system.
- Costs and health outcomes (Quality-Adjusted Life-Years - QALYs) were estimated for osimertinib and platinum-based chemotherapies (PP, GP, DP, TP).
- Two scenarios were analyzed: T790M-positive disease and all patients progressing after EGFR TKI therapy. Sensitivity analyses were performed.
Main Results:
- Osimertinib demonstrated improved QALYs (0.376-0.846) with incremental costs ($9,710-$20,299) compared to chemotherapy in both scenarios.
- Probabilistic sensitivity analysis indicated a >57% likelihood of cost-effectiveness at $30,000/QALY and >75% at $50,000/QALY.
Conclusions:
- Osimertinib is likely a cost-effective second-line treatment option for advanced NSCLC in China.
- The findings support osimertinib's value based on its recent inclusion in the National Reimbursement Drug List.
- This pharmacoeconomic evaluation provides evidence for healthcare decision-making regarding NSCLC treatment in China.
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