Cost-Effectiveness And Value of Information Analyses of Sotorasib Versus Docetaxel in Previously Treated Patients With Advanced Non-Small Cell Lung Cancer With KRAS G12C Mutation
Author(s)
Oiza B. Aliu, PharmD1, Brian L. Erstad, PharmD2, Jingjing Liang, Ph.D1, Ivo Abraham, PhD1;
1University of Arizona, Health and Pharmaceutical Outcomes, Tuscon, AZ, USA, 2University of Arizona, Pharmacy Practice and Science, Tuscon, AZ, USA
1University of Arizona, Health and Pharmaceutical Outcomes, Tuscon, AZ, USA, 2University of Arizona, Pharmacy Practice and Science, Tuscon, AZ, USA
Presentation Documents
OBJECTIVES: Sotorasib is a first-in-class oral KRAS G12C inhibitor that showed progression-free survival benefit and an improved safety profile over docetaxel in the CodeBreak 200 trial. This study aimed to evaluate the cost-effectiveness of sotorasib vs. docetaxel and to estimate the cost of uncertainty, and the potential value of collecting additional evidence using value of information analysis.
METHODS: A 3-state partitioned survival model (progression-free, progressed, death) over a 5-year time horizon and from a United States payer perspective was developed. The progression-free and overall survival estimates were determined from the Kaplan-Meier curves of the CodeBreak 200 trial based on the best-fitting parametric distribution. Costs of drugs were sourced from Redbook, administration costs from Physician Fee Schedule, and cost of adverse events management, and utilities from published literature. One-way and probabilistic sensitivity analyses (PSA) were used to account for model uncertainties. Discounting at 3% per year was utilized. Using results from the PSA, the net health benefits (NHBs) and net monetary benefits (NMBs) forgone and the population expected value of perfect information (EVPI) were calculated.
RESULTS: Sotorasib yielded an increase of 0.35 quality-adjusted life-year (QALY), at an incremental cost of $329,619. At a willingness to pay threshold (WTP) of an incremental $150,000 per QALY gained, the incremental cost-utility ratio was $941,768 per QALY gained. The probability of being cost-effective at $150,000 WTP was 3% vs. 97% for sotorasib and docetaxel respectively. The average per-patient NHBs and NMBs forgone were 0.061QALYs and $5019 respectively. The population EVPI was estimated to be $627.3 million.
CONCLUSIONS: Sotorasib may require a higher WTP threshold or a reduction in acquisition cost to be considered cost-effective. The estimated EVPI exceeds the cost of conducting another trial, future research to acquire additional evidence is considered worthwhile to inform clinical and policy decisions.
METHODS: A 3-state partitioned survival model (progression-free, progressed, death) over a 5-year time horizon and from a United States payer perspective was developed. The progression-free and overall survival estimates were determined from the Kaplan-Meier curves of the CodeBreak 200 trial based on the best-fitting parametric distribution. Costs of drugs were sourced from Redbook, administration costs from Physician Fee Schedule, and cost of adverse events management, and utilities from published literature. One-way and probabilistic sensitivity analyses (PSA) were used to account for model uncertainties. Discounting at 3% per year was utilized. Using results from the PSA, the net health benefits (NHBs) and net monetary benefits (NMBs) forgone and the population expected value of perfect information (EVPI) were calculated.
RESULTS: Sotorasib yielded an increase of 0.35 quality-adjusted life-year (QALY), at an incremental cost of $329,619. At a willingness to pay threshold (WTP) of an incremental $150,000 per QALY gained, the incremental cost-utility ratio was $941,768 per QALY gained. The probability of being cost-effective at $150,000 WTP was 3% vs. 97% for sotorasib and docetaxel respectively. The average per-patient NHBs and NMBs forgone were 0.061QALYs and $5019 respectively. The population EVPI was estimated to be $627.3 million.
CONCLUSIONS: Sotorasib may require a higher WTP threshold or a reduction in acquisition cost to be considered cost-effective. The estimated EVPI exceeds the cost of conducting another trial, future research to acquire additional evidence is considered worthwhile to inform clinical and policy decisions.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE79
Topic
Economic Evaluation
Topic Subcategory
Value of Information
Disease
SDC: Oncology