Aguiar PN, et al. - Whether osimertinib as first-line therapy is cost-effective in the treatment of epidermal growth factor receptor gene (EGFR)-mutated non–small cell lung cancer (NSCLC) was evaluated. According to World Health Organization cost-effectiveness threshold criteria, the current costs incurred by osimertinib treatment deny its cost-efficacy for first-line therapy of EGFR-mutated NSCLC in either the US or Brazil.

Methods

• In this cost-effectiveness analysis, researchers used individual patient data from the FLAURA randomized clinical trial and findings of from an earlier meta-analysis to develop a decision-analytic model.
• They compared the cost-effectiveness of osimertinib (AZD9291) vs first- and second-generation EGFR-TKIs over a 10-year time horizon.
• All direct costs were based on US and Brazilian payer perspectives.
• The incremental cost-effectiveness ratio (ICER) expressed as cost per quality-adjusted life-year (QALY) gained by using osimertinib vs first- or second-generation EGFR-TKIs in previously untreated EGFR-mutated NSCLC was considered as the main outcome.

Results

• Relative to the first- and second-generation EGFR-TKIs, the observed incremental QALY for osimertinib was 0.594 in the base case using the data as reported in the FLAURA trial.
• The reported osimertinib ICERs were $226,527 vs erlotinib, $231,123 vs gefitinib, and $219,874 vs afatinib in the US.
• Researchers found that the ICERs were $162,329, $180,804, and $175,432, respectively in Brazil.
• They also noted that the overall survival (95% CI) reported in the FLAURA trial (hazard ratio, 0.63; 95% CI, 0.45-0.88) had the strongest correlation with the ICER (ranging from $84,342 to $859,771).
• Findings revealed osimertinib price adjustments to the FLAURA trial data improved cost-effectiveness. For example, a 10% discount on osimertinib cost was associated with a 20% decrease of ICER vs the base case ICER, and a 20% discount on osimertinib cost was associated with a 40% decrease of ICER vs the base case ICER.