COST-EFFECTIVENESS OF AMIVANTAMAB PLUS LAZERTINIB FOR FIRST-LINE TREATMENT OF EGFR-MUTATED ADVANCED NON-SMALL CELL LUNG CANCER: A U.S. PAYER PERSPECTIVE
Author(s)
Lijia Zheng, PhD;
CHOICE Institute, University of Washington Seattle, Seattle, WA, USA
CHOICE Institute, University of Washington Seattle, Seattle, WA, USA
OBJECTIVES: To evaluate the cost-effectiveness of AL compared with osimertinib and osimertinib plus chemotherapy (OC) from a U.S. payer perspective.
METHODS: A three-state partitioned survival model (stable, progressed, death) was developed over a 15-year lifetime horizon. The model was informed by digitized Kaplan-Meier curves from the MARIPOSA trial with reconstructed individual patient data for AL and osimertinib. Treatment effects for OC were incorporated through indirect treatment comparison (ITC) using hazard ratios from the FLAURA2 trial. Survival extrapolation used Bayesian model averaging as the base-case approach. Costs (2025 USD) and health outcomes were discounted at 3% annually. ICERs were assessed against a willingness-to-pay threshold of $150,000 per QALY. Model uncertainty was evaluated using probabilistic sensitivity analysis and three scenario analyses: (1) value-based price reductions for AL, (2) alternative OC induction durations, and (3) uncertainty in ITC hazard ratios.
RESULTS: In the base-case analysis, AL yielded the highest health benefits with 3.28 QALYs but at a substantial lifetime cost of $1,923,130, compared with 2.39 QALYs and $946,061 for OC, and 2.15 QALYs and $714,835 for osimertinib. The ICER for AL versus the next most effective strategy (OC) was approximately $1.10 million per QALY, far exceeding the U.S. WTP threshold. While OC provided intermediate benefits, it was also not cost-effective relative to osimertinib (ICER ≈ $0.98 million/QALY). PSA indicated a <1% probability of AL being cost-effective at current prices. Scenario analyses revealed that AL’s cost-effectiveness was primarily driven by acquisition costs; AL approached thresholds only under substantial price reductions and at a 70% reduction the ICER fell well below $150,000/QALY.
CONCLUSIONS: Among first-line treatment strategies for EGFR-mutated advanced NSCLC, AL provides the greatest projected health gains but is not cost-effective at current U.S. list prices. Future pricing reforms or value-based agreements may be needed to better align the regimen’s cost with its clinical benefits.
METHODS: A three-state partitioned survival model (stable, progressed, death) was developed over a 15-year lifetime horizon. The model was informed by digitized Kaplan-Meier curves from the MARIPOSA trial with reconstructed individual patient data for AL and osimertinib. Treatment effects for OC were incorporated through indirect treatment comparison (ITC) using hazard ratios from the FLAURA2 trial. Survival extrapolation used Bayesian model averaging as the base-case approach. Costs (2025 USD) and health outcomes were discounted at 3% annually. ICERs were assessed against a willingness-to-pay threshold of $150,000 per QALY. Model uncertainty was evaluated using probabilistic sensitivity analysis and three scenario analyses: (1) value-based price reductions for AL, (2) alternative OC induction durations, and (3) uncertainty in ITC hazard ratios.
RESULTS: In the base-case analysis, AL yielded the highest health benefits with 3.28 QALYs but at a substantial lifetime cost of $1,923,130, compared with 2.39 QALYs and $946,061 for OC, and 2.15 QALYs and $714,835 for osimertinib. The ICER for AL versus the next most effective strategy (OC) was approximately $1.10 million per QALY, far exceeding the U.S. WTP threshold. While OC provided intermediate benefits, it was also not cost-effective relative to osimertinib (ICER ≈ $0.98 million/QALY). PSA indicated a <1% probability of AL being cost-effective at current prices. Scenario analyses revealed that AL’s cost-effectiveness was primarily driven by acquisition costs; AL approached thresholds only under substantial price reductions and at a 70% reduction the ICER fell well below $150,000/QALY.
CONCLUSIONS: Among first-line treatment strategies for EGFR-mutated advanced NSCLC, AL provides the greatest projected health gains but is not cost-effective at current U.S. list prices. Future pricing reforms or value-based agreements may be needed to better align the regimen’s cost with its clinical benefits.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE471
Topic
Economic Evaluation
Topic Subcategory
Thresholds & Opportunity Cost, Trial-Based Economic Evaluation
Disease
SDC: Oncology