Osimertinib in first-line treatment of advanced EGFR-mutated non-small-cell lung cancer: a cost–effectiveness analysis
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: Osimertinib improves progression-free survival in first-line EGFR mutation–positive non-small-cell lung cancer. Materials & methods: A Markov cohort model including costs, utilities and disutilities, was conducted to estimate quality-adjusted life-year (QALY) and incremental cost–effectiveness ratio when treating with osimertinib versus standard first-line tyrosine kinase inhibitors (TKIs). Results: Osimertinib presented higher QALYs (0.61) compared with standard EGFR–TKIs (0.42). Osimertinib costs were €83,258.99, in comparison with €29,209.45 for the standard EGFR–TKIs. An incremental cost–effectiveness ratio of €273,895.36/QALY was obtained for osimertinib. Conclusion: Osimertinib was more effective in terms of QALYs gained than comparators (erlotinib–gefitinib). However, to obtain a cost–effectiveness alternative, a discount greater than 60% in osimertinib acquisition cost is required.
Supplementary Material
References
1.
Sharma SV, Bell DW, Settleman J, Haber DA. Epidermal growth factor receptor mutations in lung cancer. Nat. Rev. Cancer 7(3), 169–181 (2007).
2.
Esteban E, Majem M, Martinez Aguillo M et al. Prevalence of EGFR mutations in newly diagnosed locally advanced or metastatic non-small cell lung cancer Spanish patients and its association with histological subtypes and clinical features: the Spanish REASON study. Cancer Epidemiol. 39(3), 291–297 (2015).
3.
Jänne PA, Wang X, Socinski MA et al. Randomized Phase II trial of erlotinib alone or with carboplatin and paclitaxel in patients who were never or light former smokers with advanced lung adenocarcinoma: CALGB 30406 trial. J. Clin. Oncol. 30(17), 2063–2069 (2012).
4.
Rosell R, Moran T, Queralt C et al. Screening for epidermal growth factor receptor mutations in lung cancer. N. Engl. J. Med. 361(10), 958–967 (2009).
5.
Gao G, Ren S, Li A et al. Epidermal growth factor receptor-tyrosine kinase inhibitor therapy is effective as first-line treatment of advanced non-small-cell lung cancer with mutated EGFR: A meta-analysis from six Phase III randomized controlled trials. Int. J. Cancer 131(5), E822–E829 (2012).
6.
Maemondo M, Inoue A, Kobayashi K et al. Gefitinib or chemotherapy for non-small-cell lung cancer with mutated EGFR. N. Engl. J. Med. 362(25), 2380–2388 (2010).
7.
Mitsudomi T, Morita S, Yatabe Y et al. Gefitinib versus cisplatin plus docetaxel in patients with non-small-cell lung cancer harbouring mutations of the epidermal growth factor receptor (WJTOG3405): an open label, randomised Phase 3 trial. Lancet Oncol. 11(2), 121–128 (2010).
8.
Zhou C, Wu Y-L, Chen G et al. Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer (OPTIMAL, CTONG-0802): a multicentre, open-label, randomised, Phase 3 study. Lancet Oncol. 12(8), 735–742 (2011).
9.
Yun C-H, Mengwasser KE, Toms AV et al. The T790M mutation in EGFR kinase causes drug resistance by increasing the affinity for ATP. Proc. Natl Acad. Sci. USA 105(6), 2070–2075 (2008).
10.
Sos ML, Rode HB, Heynck S et al. Chemogenomic profiling provides insights into the limited activity of irreversible EGFR Inhibitors in tumor cells expressing the T790M EGFR resistance mutation. Cancer Res. 70(3), 868–874 (2010).
11.
Cross DAE, Ashton SE, Ghiorghiu S et al. AZD9291, an irreversible EGFR–TKI, overcomes T790M-mediated resistance to EGFR inhibitors in lung cancer. Cancer Discov. 4(9), 1046–1061 (2014).
12.
Goss G, Tsai C-M, Shepherd FA et al. Osimertinib for pretreated EGFR Thr790Met-positive advanced non-small-cell lung cancer (AURA2): a multicentre, open-label, single-arm, Phase 2 study. Lancet Oncol. 17(12), 1643–1652 (2016).
13.
Yang JC-H, Ahn M-J, Kim D-W et al. Osimertinib in pretreated T790M-positive advanced non-small-cell lung cancer: AURA Study Phase II extension component. J. Clin. Oncol. 35(12), 1288–1296 (2017).
14.
Mok TS, Wu Y-L, Ahn M-J et al. Osimertinib or platinum-pemetrexed in EGFR T790M-positive lung cancer. N. Engl. J. Med. 376(7), 629–640 (2017).
15.
Soria J-C, Ohe Y, Vansteenkiste J et al. Osimertinib in untreated EGFR-mutated advanced non-small-cell lung cancer. N. Engl. J. Med. 378(2), 113–125 (2018).
16.
Ezeife DA, Kirk V, Chew DS et al. Economic analysis of osimertinib in previously untreated EGFR-mutant advanced non-small cell lung cancer in Canada. Lung Cancer 125, 1–7 (2018).
17.
Aguiar PN, Haaland B, Park W, San Tan P, Del Giglio A, de Lima Lopes G. Cost–effectiveness of osimertinib in the first-line treatment of patients with EGFR-mutated advanced non-small cell lung cancer. JAMA Oncol. 4(8), 1080–1084 (2018).
18.
Vallejo-Torres L, García-Lorenzo B, Serrano-Aguilar P. Estimating a cost–effectiveness threshold for the Spanish NHS. Health Econ. 27(4), 746–761 (2018).
19.
Guyot P, Ades AE, Ouwens MJNM, Welton NJ. Enhanced secondary analysis of survival data: reconstructing the data from published Kaplan–Meier survival curves. BMC Med. Res. Methodol. 12, 9 (2012).
20.
Spanish Healthcare Ministry. Drug prices (2017). www.aemps.gob.es/cima/publico/home.html
21.
Spanish Healthcare Ministry. Official discounts in drug prices (2017). www.msssi.gob.es/profesionales/farmacia/pdf/DeduccionesJunio2017.pdf
22.
Departamento de Salud. ORDRE SLT/30/2013, de 20 de febrero, per la qual s'aproven els preus públics del Servei Catalá de la Salut. Orden SLT/30/2013, 20 Febrero, 2013. Diari Oficial de la Generalitat de Catalunya Núm 6323. Diari Oficial de la Generalitat de Catalunya. (2013).
23.
Martín Escudero V, Garcia del Muro X, Trigo J. Uso de los recursos y costes asociados con el manejo de los acontecimientos adversos asociado al uso de terapias dirigidas en el tratamiento del carcinoma de células renales metastásico en España. In: Jornadas de Economía de la Salud (2010).
24.
Nafees B, Lloyd AJ, Dewilde S, Rajan N, Lorenzo M. Health state utilities in non-small cell lung cancer: an international study. Asia Pac. J. Clin. Oncol. 13(5), e195–e203 (2017).
25.
Nafees B, Stafford M, Gavriel S, Bhalla S, Watkins J. Health state utilities for non-small-cell lung cancer. Health Qual. Life Outcomes 6, 84 (2008).
26.
Barton GR, Briggs AH, Fenwick EAL. Optimal cost–effectiveness decisions: the role of the cost–effectiveness acceptability curve (CEAC), the cost–effectiveness acceptability frontier (CEAF), and the expected value of perfection information (EVPI). Value Health 11(5), 886–897 (2008).
27.
Aalabaf-Sabaghi M. Decision modelling for health economic evaluation. J. Epidemiol. Community Health. 61(9), 839 (2007).
28.
Bertranou E, Bodnar C, Dansk V, Greystoke A, Large S, Dyer M. Cost–effectiveness of osimertinib in the UK for advanced EGFR-T790M non-small cell lung cancer. J. Med. Econ. 21(2), 113–121 (2018).
29.
Wu B, Gu X, Zhang Q. Cost–effectiveness of osimertinib for EGFR mutation-positive non-small cell lung cancer after progression following first-line EGFR–TKI therapy. J. Thorac. Oncol. 13(2), 184–193 (2018).
30.
Adalsteinsson E, Toumi M. Benefits of probabilistic sensitivity analysis – a review of NICE decisions. J. Mark. Access Health Policy 1, (2013).
31.
Epstein AM. Will pay for performance improve quality of care? The answer is in the details. N. Engl. J. Med. 367(19), 1852–1853 (2012).
32.
Sutton M, Nikolova S, Boaden R, Lester H, McDonald R, Roland M. Reduced mortality with hospital pay for performance in England. N. Engl. J. Med. 367(19), 1821–1828 (2012).
33.
Cherny NI, Sullivan R, Dafni U et al. ESMO – Magnitude of Clinical Benefit Scale V.1.0 questions and answers. ESMO Open 1(5), e000100 (2016).
34.
Schnipper LE, Davidson NE, Wollins DS et al. American Society of Clinical Oncology statement: a conceptual framework to assess the value of cancer treatment options. J. Clin. Oncol. 33(23), 2563–2577 (2015).
35.
Stiggelbout AM, Kiebert GM, Kievit J, Leer JW, Stoter G, de Haes JC. Utility assessment in cancer patients: adjustment of time tradeoff scores for the utility of life years and comparison with standard gamble scores. Med. Decis. Making 14(1), 82–90 (1994).
36.
Yang JC-H, Shih J-Y, Su W-C et al. Afatinib for patients with lung adenocarcinoma and epidermal growth factor receptor mutations (LUX-Lung 2): a Phase 2 trial. Lancet Oncol. 13(5), 539–548 (2012).
Information & Authors
Information
Published In
Pages: 853 - 863
PubMed: 31478399
Copyright
© 2019 Future Medicine Ltd.
History
Received: 19 February 2019
Accepted: 3 May 2019
Published online: 3 September 2019
Keywords:
Topics
Authors
Metrics & Citations
Metrics
Article Usage
Article usage data only available from February 2023. Historical article usage data, showing the number of article downloads, is available upon request.
Citations
How to Cite
Osimertinib in first-line treatment of advanced EGFR-mutated non-small-cell lung cancer: a cost–effectiveness analysis. (2019) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2019-0029
Export citation
Select the citation format you wish to export for this article or chapter.
Citing Literature
- Li-Jung Elizabeth Ku, Jui-Hung Tsai, Li-Jun Chen, Szu-Chun Yang, Cost-effectiveness of lazertinib as first-line treatment in patients with EGFR -mutated advanced lung cancer , Therapeutic Advances in Medical Oncology, 10.1177/17588359241312143, 17, (2025).
- Angie Raad, Maria Rizzo, Katherine Appiah, Isabella Kearns, Luis Hernandez, Critical Examination of Modeling Approaches Used in Economic Evaluations of First-Line Treatments for Locally Advanced or Metastatic Non-Small Cell Lung Cancer Harboring Epidermal Growth Factor Receptor Mutations: A Systematic Literature Review, PharmacoEconomics, 10.1007/s40273-024-01362-2, 42, 5, (527-568), (2024).
- Rodrigo Motta-Guerrero, Alejandro Leon Garrido-Lecca, Virgilio E. Failoc-Rojas, Ana Calle-Villavicencio, Robert Villacorta-Carranza, Yesenia Huerta-Collado, Alicia Torres-Mera, Mario J. Valladares-Garrido, Víctor Rivera-Francia, Carlos Carracedo, Luis Raez, Effectiveness and safety of the bevacizumab and erlotinib combination versus erlotinib alone in EGFR mutant metastatic non-small-cell lung cancer: systematic review and meta-analysis, Frontiers in Oncology, 10.3389/fonc.2023.1335373, 13, (2024).
- Alejandro Vila Pérez, Emilio J. Alegre-del Rey, Silvia Fénix-Caballero, Zuzana Špacírová, Petra Rosado Varela, Antonio Olry de Labry Lima, Economic evaluation of adjuvant therapy with osimertinib in patients with early-stage non–small cell lung cancer and mutated EGFR, Supportive Care in Cancer, 10.1007/s00520-023-08239-8, 32, 1, (2023).
- Mousa Alali, Maher Saifo, Optimizing the Treatment for Advanced Non–Small-Cell Lung Cancer with Mutated Epidermal Growth Factor Receptor in Low-Income Countries: A Review, Journal of Immunotherapy and Precision Oncology, 10.36401/JIPO-22-29, 6, 3, (140-149), (2023).
- Yamin Shu, Yufeng Ding, Xucheng He, Yanxin Liu, Pan Wu, Qilin Zhang, Cost-effectiveness of osimertinib versus standard EGFR-TKI as first-line treatment for EGFR-mutated advanced non-small-cell lung cancer in China, Frontiers in Pharmacology, 10.3389/fphar.2022.920479, 13, (2022).
- Joo-Young Byun, Sun-Kyeong Park, Boon Peng Ng, Yi-Shao Liu, Chae-Rin Kim, Chanhyun Park, A systematic review of economic evaluations of tyrosine kinase inhibitors for non-small cell lung cancer (NSCLC), Expert Opinion on Pharmacotherapy, 10.1080/14656566.2022.2095203, 23, 11, (1247-1257), (2022).
- Haijing Guan, Chunping Wang, Chen Chen, Sheng Han, Zhigang Zhao, Cost-Effectiveness of 12 First-Line Treatments for Patients With Advanced EGFR Mutated NSCLC in the United Kingdom and China, Frontiers in Oncology, 10.3389/fonc.2022.819674, 12, (2022).
- Shahin Nargesi, Zeinab Dolatshahi, Aziz Rezapour, Vahid Alipour, Aghdas Souresrafil, Hiro Farabi, Seyed Arash Javadmoosavi, Mandana Safakhah, Najmeh Moradi, Cost-effectiveness of osimertinib in the treatment of advanced EGFR-mutated non-small cell lung cancer: a systematic review, Expert Review of Pharmacoeconomics & Outcomes Research, 10.1080/14737167.2022.2011721, 22, 4, (543-554), (2021).
- J Aguilar-Serra, V Gimeno-Ballester, a Pastor-Clerigues, J Milara, C Trigo-Vicente, J Cortijo, Cost-effectiveness analysis of the first‐line EGFR‐TKIs in patients with advanced EGFR-mutated non-small-cell lung cancer, Expert Review of Pharmacoeconomics & Outcomes Research, 10.1080/14737167.2022.1987220, 22, 4, (637-646), (2021).