COST-EFFECTIVENESS OF LAZERTINIB-AMIVANTAMAB COMPARED TO OSIMERTINIB FOR NON-SMALL CELL LUNG CANCER: A 5-YEAR PARTITIONED SURVIVAL MODEL
Author(s)
Nissen Weisman, PharmD, MSc HEOR1, David Veenstra, PharmD, PhD2;
1Genentech & CHOICE Institute, University of Washington, Seattle, WA, USA, 2CHOICE Institute, University of Washington, Seattle, WA, USA
1Genentech & CHOICE Institute, University of Washington, Seattle, WA, USA, 2CHOICE Institute, University of Washington, Seattle, WA, USA
OBJECTIVES: To estimate the cost-effectiveness of lazertinib combined with amivantamab (LA) vs. osimertinib for the first-line treatment of non-small cell lung cancer (NSCLC) with EGFR exon 19 deletion or exon 21 L858R mutation.
METHODS: We used a partitioned survival model to estimate the incremental cost per quality-adjusted life year (QALY) using clinical data from the MARIPOSA trial. We extracted data from the Kaplan-Meier curves for progression-free survival (PFS) and overall survival (OS) for both LA and osimertinib. We determined which parametric curve (log-logistic, Weibull, log-normal, gamma, or exponential) had the lowest Akaike's information criterion (AIC) for each of the four curves: gamma for the LA PFS (AIC = 1744.891), log-logistic for osimertinib PFS (AIC = 2091.824), exponential for LA OS (AIC = 1042.213), and Weibull for osimertinib OS (AIC = 1214.335). Drug costs were based on a 30-day supply using the average wholesale price in US dollars, resulting in $37,381 for LA and $17,459 for osimertinib. The time horizon was 5 years based on the expected survival in NSCLC. We used an average starting age of 63.5 years based on trial data. We used a utility of 0.676 and 0.473 for progression-free and progressed NSCLC (Nafees 2008). We ran a one-way sensitivity analysis and a probabilistic sensitivity analysis (PSA) to assess uncertainty.
RESULTS: Total costs were $2,172,000 for LA and $725,300 for osimertinib. Total QALYs were 32.3 for LA and 24.51 for osimertinib, resulting in an ICER of $185,600. The cost of LA was the major driver of cost. The PSA showed a 30% chance of being cost-effective at a willingness-to-pay (WTP) of $150,000 and 50% at $174,000.
CONCLUSIONS: Based on these preliminary results, we found that LA may not be cost-effective over a 5-year time frame compared to osimertinib at a WTP of $150,000. Analyses using a lifetime perspective are ongoing.
METHODS: We used a partitioned survival model to estimate the incremental cost per quality-adjusted life year (QALY) using clinical data from the MARIPOSA trial. We extracted data from the Kaplan-Meier curves for progression-free survival (PFS) and overall survival (OS) for both LA and osimertinib. We determined which parametric curve (log-logistic, Weibull, log-normal, gamma, or exponential) had the lowest Akaike's information criterion (AIC) for each of the four curves: gamma for the LA PFS (AIC = 1744.891), log-logistic for osimertinib PFS (AIC = 2091.824), exponential for LA OS (AIC = 1042.213), and Weibull for osimertinib OS (AIC = 1214.335). Drug costs were based on a 30-day supply using the average wholesale price in US dollars, resulting in $37,381 for LA and $17,459 for osimertinib. The time horizon was 5 years based on the expected survival in NSCLC. We used an average starting age of 63.5 years based on trial data. We used a utility of 0.676 and 0.473 for progression-free and progressed NSCLC (Nafees 2008). We ran a one-way sensitivity analysis and a probabilistic sensitivity analysis (PSA) to assess uncertainty.
RESULTS: Total costs were $2,172,000 for LA and $725,300 for osimertinib. Total QALYs were 32.3 for LA and 24.51 for osimertinib, resulting in an ICER of $185,600. The cost of LA was the major driver of cost. The PSA showed a 30% chance of being cost-effective at a willingness-to-pay (WTP) of $150,000 and 50% at $174,000.
CONCLUSIONS: Based on these preliminary results, we found that LA may not be cost-effective over a 5-year time frame compared to osimertinib at a WTP of $150,000. Analyses using a lifetime perspective are ongoing.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE265
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology