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Osimertinib not cost-effective for EGFR-mutated lung cancer
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Osimertinib did not appear cost-effective as a first-line therapy for EGFR-mutated non-small cell lung cancer in either the United States or Brazil, according to findings published in JAMA Oncology.
“Recently, in the FLAURA trial, osimertinib [Tagrisso, AstraZeneca] was compared with first-generation EGFR TKIs in treatment-naive patients with advanced NSCLC and EGFR mutation,” Gilberto de Lima Lopes Jr., MD, FAMS, MBA, associate professor at Sylvester Comprehensive Cancer Center at University of Miami, and colleagues wrote. “Median PFS was superior with osimertinib. Based on these results, the National Comprehensive Cancer Network incorporated osimertinib as a first-line option in its guidelines.”
The researchers used patient data from the FLAURA clinical trial to perform a cost-effectiveness analysis based on the perspectives of payers in the U.S. and Brazil. Lopes and colleagues developed a decision-analytic model to compare the cost-effectiveness of osimertinib with that of first- and second-generation EGFR TKIs over 10 years.
The incremental cost-effectiveness ratio (ICER) expressed as the cost per quality-adjusted life-year gained with osimertinib compared with first- or second-generation EGFR TKIs among patients with treatment-naive EGFR-mutated NSCLC served as the main outcome.
In the U.S., osimertinib cost $17,028.90 per month, compared erlotinib (Tarceva, Genentech) at $9,390.44, gefitinib (Iressa, AstraZeneca) at $9,117.36 and afatinib (Gilotrif, Boehringer Ingelheim) at $9,785.72. In Brazil, the monthly drug costs were $8789.96 for osimertinib, $2,127.60 for erlotinib, $1,029.94 for gefitinib and $1,349.19 for afatinib.
The number of incremental quality-adjusted life-years gained with osimertinib was 0.594 compared with older EGFR TKIs.
In the U.S., osimertinib had an ICER of $226,527 compared with erlotinib, $231,123 compared with gefitinib and $219,874 compared with afatinib. The corresponding with ICERs in Brazil were $162,329 compared with erlotinib, $180,804 compared with gefitinib and $175,432 compared with afatinib.
OS in the trial (HR = 0.63; 95% CI, 0.45-0.88) served as the factor most strongly associated with the ICER (range, $84,342-$859,771).
When Lopes and colleagues adjusted the price of osimertinib in the trial data, the cost-effectiveness improved. A 10% discount on osimertinib lowered the ICER by 20% in the U.S. compared with baseline, and a 20% discount appeared associated with a 40% decrease in the ICER.
“Despite being highly efficacious in the first-line treatment of patients with advanced EGFR-mutated NSCLC, osimertinib, due to its high cost, was not cost-effective in our model in either the United States or Brazil,” the researchers wrote. “... All stakeholders in health care systems have the responsibility to be part of the solution. Our role as oncologists and researchers is to continue generating data and to communicate our findings to all relevant persons and institutions.” – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.
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