Presentation (CTI)

OBJECTIVES: Analyze the relationship between clinical outcomes, particularly mPFS, and launch prices of targeted therapies in NSCLC across different mutations (ALK+, EGFR, KRAS G12C+, ROS1+, METex14+) for US FDA-approved therapies from 2017 to 2025.
METHODS: Analysis included 14 FDA-approved NSCLC targeted therapies (2017-2025). Drug costs were computed from Wholesale Acquisition Costs (WAC) at FDA approval from Analysource™. Monthly costs and Average annual cost per mPFS month were calculated using pivotal trial data as primary outcome, while Duration of Treatment (DoT) adjusted costs were used for sensitivity analysis.
RESULTS: Monthly therapy costs demonstrated biomarker agnostic pricing (mean: $21,219, SD: $4,728), regardless of mutation prevalence or line of therapy. The cost per mPFS month ranged from $7,895 (taletrectinib in 1L) to $48,618 (amivantamab in 2L). Among approved first-line therapies (mean PFS: 21.56 months), cost per mPFS month also varied substantially from $7,895 to $26,867. The variation was evident even within mutation types highlighting potential discrepancies in value (e.g., ROS1: $7,760 [taletrectinib] to $9,693 [repotrectinib] to $13,019 [entrectinib]; RET: $11,393 [selpercatinib] to $15,859[pralsetinib]). The rank order of Average annual cost per mPFS month for 1L therapies was as follows: ALK+ ($8,093); ROS1+ ($10,158); EGFR ex19/ex21 ($11,455); RET+ ($13,626); METex14+ ($19,450); EGFR ex20 ($26,867). Second-line therapies demonstrated higher cost per PFS month, as expected. DoT-adjusted analyses confirmed these patterns.
CONCLUSIONS: Despite relatively consistent monthly costs, cost per mPFS month varies significantly within mutation groups. First-line therapies demonstrate superior value, supporting early biomarker testing. Emerging targeted therapies show potential for further improving value propositions through enhanced clinical outcomes.