Cost-Effectiveness of Combination Amivantamab-Lazertinib, Osimertinib Plus Chemotherapy, and Osimertinib Monotherapy
Jui-Hung Tsai1,2, Sheng-Han Tsai3,4, Li-Jun Chen4
11Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Background:
Combination amivantamab-lazertinib, osimertinib + chemotherapy, and osimertinib monotherapy are the current standard first-line therapies for treatment-naïve patients with EGFR-mutated advanced lung cancer. We aim to compare the cost-effectiveness of all 3 regimens.
Methods:
This economic evaluation with a 20-year time horizon and annual 3% discount was conducted from the perspective of the health care sectors in Taiwan and the Unites States (US). Simulated patients were entered into partitioned survival models upon initiation of amivantamab-lazertinib, osimertinib + chemotherapy, and osimertinib monotherapy. Model inputs were derived from trials and network meta-analyses (progression-free/overall survival, adverse events, and subsequent therapies), insurance payments or retail prices (costs of drug administration, physician visits, monitoring, and end-of-life care), and hospital cohorts (health utility). Subgroup, one-way deterministic, and probabilistic analyses were performed.
Results:
The incremental cost-effectiveness ratios (ICERs) of osimertinib + chemotherapy versus osimertinib monotherapy (Taiwan: $231,234 per quality-adjusted life-year [QALY]; US: $442,506/QALY) and amivantamab-lazertinib versus osimertinib + chemotherapy (Taiwan: $412,332/QALY; US: $2,623,132/QALY) exceeded willingness-to-pay (WTP) thresholds (Taiwan: $70,000/QALY; US: $150,000/QALY). Cost of drugs and adverse event management accounted for the main cost differences among the 3 strategies. ICERs remained higher than WTP thresholds across patient subgroups. The lowest ICER for amivantamab-lazertinib versus osimertinib + chemotherapy (Taiwan: $232,192/QALY; US: $1,319,408/QALY) was noted among patients aged ≥65 years. Osimertinib + chemotherapy had a 2.0% (Taiwan) and 0.4% (US) probability of being cost-effective at the respective WTP thresholds, with amivantamab-lazertinib showing an even lower probability.
Conclusions:
Our analysis suggests that despite the superior efficacy of amivantamab-lazertinib and osimertinib + chemotherapy, neither is cost-effective compared with osimertinib as first-line treatment for EGFR-mutated advanced lung cancer.
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