First-line osimertinib with or without chemotherapy for EGFR-mutant advanced NSCLC in China: a cost-effectiveness...

To evaluate the cost-effectiveness of adding chemotherapy to first-line osimertinib compared with osimertinib alone among advanced non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations in China.

A partitioned survival model was developed to project lifetime costs and health outcomes. Model inputs included direct medical costs, utility, and clinical parameters. Deterministic and probabilistic sensitivity analyses were conducted to assess parameter uncertainty. The primary outcomes were total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs).

Osimertinib plus chemotherapy was associated with higher costs ($62,338.96 vs. $46,929.04) and greater QALYs (3.60 vs. 2.88) than monotherapy, yielding an ICER of $21,410.25 per QALY. Drug costs contributed most to the incremental costs in both arms. Deterministic sensitivity analysis identified the cost of pemetrexed as the most influential parameter. At its highest price, the ICER exceeded the willingness‑to‑pay threshold of $41,876.05 per QALY (three times China's 2025 per capita GDP); otherwise, results remained robust. Probabilistic sensitivity analysis indicated that the combination strategy had a 96.28% probability of being cost-effective. However, these findings should be interpreted with caution, given the extrapolated nature of the survival data.

Compared with osimertinib alone, osimertinib plus chemotherapy was likely to be cost-effective as first-line treatment for EGFR-mutated advanced NSCLC in China, but this cost-effectiveness was highly sensitive to the price of pemetrexed.