Evaluation of Cost-Effectiveness of Adjuvant Osimertinib in Patients with Resected EGFR Mutation-Positive Non-small Cell Lung Cancer

Andre Verhoek (), Parneet Cheema, Barbara Melosky, Benoit Samson, Frances A. Shepherd, Filippo Marinis, Thomas John, Yi-Long Wu, Bart Heeg, Nadia Dalfsen, Benjamin Bracke, Miguel Miranda, Simon Shaw and Daniel Moldaver
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Andre Verhoek: Cytel
Parneet Cheema: University of Toronto
Barbara Melosky: BC Cancer
Benoit Samson: Charles LeMoyne Hospital Cancer Center
Frances A. Shepherd: University Health Network, Princess Margaret Cancer Centre and the University of Toronto
Filippo Marinis: European Institute of Oncology, IRCCS
Thomas John: Austin Health
Yi-Long Wu: Guangdong Provincial People’s Hospital and Guangdong Academy of Medical Sciences
Bart Heeg: Cytel
Nadia Dalfsen: Cytel
Benjamin Bracke: AstraZeneca
Miguel Miranda: AstraZeneca
Simon Shaw: AstraZeneca
Daniel Moldaver: AstraZeneca

PharmacoEconomics - Open, 2023, vol. 7, issue 3, No 11, 455-467

Abstract: Abstract Background For many patients with resected epidermal growth factor receptor mutation-positive (EGFRm) non-small cell lung cancer (NSCLC), current standard of care (SoC) is adjuvant chemotherapy; however, disease recurrence remains high. Based on positive results from ADAURA (NCT02511106), adjuvant osimertinib was approved for treatment of resected stage IB‒IIIA EGFRm NSCLC. Objective The aim was to assess the cost-effectiveness of adjuvant osimertinib in patients with resected EGFRm NSCLC. Methods A five-health-state, state-transition model with time dependency was developed to estimate lifetime (38 years) costs and survival of resected EGFRm patients treated with adjuvant osimertinib or placebo (active surveillance), with/without prior adjuvant chemotherapy, using a Canadian Public Healthcare perspective. Transitions between health states were modeled using ADAURA and FLAURA (NCT02296125) data, Canadian life tables, and real-world data (CancerLinQ Discovery®). The model used a ‘cure’ assumption: patients remaining disease free for 5 years after treatment completion for resectable disease were deemed ‘cured.’ Health state utility values and healthcare resource usage estimates were derived from Canadian real-world evidence. Results In the reference case, adjuvant osimertinib treatment led to a mean 3.20 additional quality-adjusted life-years (QALYs; (11.77 vs 8.57) per patient, versus active surveillance. The modeled median percentage of patients alive at 10 years was 62.5% versus 39.3%, respectively. Osimertinib was associated with mean added costs of Canadian dollars (C$)114,513 per patient and a cost/QALY (incremental cost-effectiveness ratio) of C$35,811 versus active surveillance. Model robustness was demonstrated by scenario analyses. Conclusions In this cost-effectiveness assessment, adjuvant osimertinib was cost-effective compared with active surveillance for patients with completely resected stage IB‒IIIA EGFRm NSCLC after SoC.

Date: 2023
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DOI: 10.1007/s41669-023-00396-0

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