Quantifying Treatment Value Using Alternative Health Benefit Metrics: A Case Study of Adjuvant Osimertinib for Elderly Patients with EGFR mutated NSCLC Following Resection
Author(s)
Rahul Shenolikar, PhD1, Rachel Salomonsen, MPH, PhD1, Anuj Shah, PhD1, Shanshan Wang, MPH2, Stephanie Wise, Other3, Sukhvinder S. Johal, PhD3, Sara Sullivan, Other1, Sanjana Muthukrishnan, MA2, Jason Shafrin, PhD4;
1AstraZeneca Pharmaceuticals LP, Gaithersburg, MD, USA, 2FTI Consulting, Washington, DC, USA, 3AstraZeneca Pharmaceuticals LP, Cambridge, United Kingdom, 4FTI Consulting, Los Angeles, CA, USA
1AstraZeneca Pharmaceuticals LP, Gaithersburg, MD, USA, 2FTI Consulting, Washington, DC, USA, 3AstraZeneca Pharmaceuticals LP, Cambridge, United Kingdom, 4FTI Consulting, Los Angeles, CA, USA
OBJECTIVES: Traditional cost effectiveness analysis uses quality-adjusted life years (QALYs) to assess health benefits, however alternative measures are being considered as alternatives for evaluating healthcare interventions. We quantified the economic value of adjuvant osimertinib in completely resected elderly patients with EGFR-mutated NSCLC using four different quantitative health benefit measures.
METHODS: A 5-health-state state-transition model compared the lifetime costs and health gains of adjuvant osimertinib with placebo among completely resected Stage IB-IIIA EGFR-mutated NSCLC patients aged ≥65 over a 35-year time horizon. Efficacy and safety were drawn from the ADAURA trial (NCT02511106) and costs obtained from the literature. A US payer perspective and societal perspective incorporating productivity and caregiver impacts, was used. Three novel metrics for health gains were equal value of life years gained (evLYG), health years in total (HYT), and generalized risk-adjusted quality-adjusted life years gained (GRA-QALYs). EvLYG is akin to QALY but assigns a utility value of 0.851 to life-extension, HYT values survival gains at full health (1.0) and incorporates post-survival quality of life improvements, GRA-QALY adjusts risk preferences and disease severity. Willingness-to-pay (WTP) thresholds were $150,000 per QALY and per evLYG, corresponding to a WTP threshold of $89,000 per HYT and $122,107 per GRA-QALY.
RESULTS: The incremental health benefits of osimertinib (vs. placebo) were 0.71 QALYs, corresponding to 0.84 evLYG, 1.03 HYT gained and 0.86 GRA-QALY gained. The incremental costs associated with Osimertinib were $101,862 from a payer perspective, and $71,617 from a societal perspective. From a payer perspective, the incremental cost-effectiveness ratio (ICER) for osimertinib was $144,160/QALY, $120,690/evLYG, $98,548/HYT, and $118,054/GRA-QALY. When considering the societal perspective, which includes productivity and caregiver impact, the ICERs improved to $101,355/QALY, $84,853/evLYG, $69,287/HYT, and $83,001/GRA-QALY.
CONCLUSIONS: Compared to placebo, adjuvant osimertinib is cost-effective using various health benefit measures in completely resected EGFR mutated NSCLC elderly patients.
METHODS: A 5-health-state state-transition model compared the lifetime costs and health gains of adjuvant osimertinib with placebo among completely resected Stage IB-IIIA EGFR-mutated NSCLC patients aged ≥65 over a 35-year time horizon. Efficacy and safety were drawn from the ADAURA trial (NCT02511106) and costs obtained from the literature. A US payer perspective and societal perspective incorporating productivity and caregiver impacts, was used. Three novel metrics for health gains were equal value of life years gained (evLYG), health years in total (HYT), and generalized risk-adjusted quality-adjusted life years gained (GRA-QALYs). EvLYG is akin to QALY but assigns a utility value of 0.851 to life-extension, HYT values survival gains at full health (1.0) and incorporates post-survival quality of life improvements, GRA-QALY adjusts risk preferences and disease severity. Willingness-to-pay (WTP) thresholds were $150,000 per QALY and per evLYG, corresponding to a WTP threshold of $89,000 per HYT and $122,107 per GRA-QALY.
RESULTS: The incremental health benefits of osimertinib (vs. placebo) were 0.71 QALYs, corresponding to 0.84 evLYG, 1.03 HYT gained and 0.86 GRA-QALY gained. The incremental costs associated with Osimertinib were $101,862 from a payer perspective, and $71,617 from a societal perspective. From a payer perspective, the incremental cost-effectiveness ratio (ICER) for osimertinib was $144,160/QALY, $120,690/evLYG, $98,548/HYT, and $118,054/GRA-QALY. When considering the societal perspective, which includes productivity and caregiver impact, the ICERs improved to $101,355/QALY, $84,853/evLYG, $69,287/HYT, and $83,001/GRA-QALY.
CONCLUSIONS: Compared to placebo, adjuvant osimertinib is cost-effective using various health benefit measures in completely resected EGFR mutated NSCLC elderly patients.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
P50
Topic
Economic Evaluation
Disease
SDC: Oncology