Cost-Effectiveness of Adjuvant Osimertinib in Resected EGFR-Mutated NSCLC Patients

Although adjuvant osimertinib is approved for resected stage IB to IIIA EGFR-mutated non–small-cell lung cancer (NSCLC) based on demonstrated disease-free survival (DFS) benefits from the ADAURA trial, early clinical adoption has been restrained largely due to the lack of overall survival (OS) benefit data and associated high drug costs. The current study was undertaken to evaluate the cost-effectiveness of adjuvant osimertinib use in patients with EGFR-mutated NSCLC enrolled in the ADAURA trial.

Using the Markov model with DFS data digitized for best fit from the ADAURA trial, the cost and quality-adjusted life-years (QALYs) of 3 years of adjuvant osimertinib use versus placebo were estimated over a 10-year time frame. All patients with progressive disease (PD) were assumed to be retreated with osimertinib. A 2% to 3% discount per year was adjusted to costs and QALYs, cost-effectiveness threshold of $195,000 was established, and cost/utility values were derived from Medicare reimbursement and recent literature.

The incremental cost-effectiveness ratio (ICER) for adjuvant osimertinib was $317,119 per QALY gained. During the 10-year period, costs of osimertinib were higher than placebo in the first 3 years, but became lower year 4 onward, with costs being similar after year 7. PD-related costs were higher in the placebo group compared with the osimertinib group through the first 6.5 years (pre-PD costs: $2388 vs $505,775; post-PD costs: $379,047 vs $255,638; total costs: $502,937 vs $800,697). QALYs in the osimertinib arm were higher at all time points. Sensitivity analysis using incremental OS gains reached the cost-effectiveness threshold of $195,000 between 25% and 30% OS benefit of osimertinib over placebo. A 50% discount to the osimertinib annual cost yielded an ICER of $115,419.

Based on these results, it was concluded that 3 years of adjuvant osimertinib is more cost-effective than placebo, with $317,119.90 per QALY gained, an OS benefit between 25% and 30% over placebo; 50% discount to osimertinib annual costs also improves the ICER significantly.

Source: Lemmon C, et al. J Clin Oncol. 2021;39(suppl 15):Abstract 8527.