OBJECTIVES: To analyse the budget impact of afatinib vs. osimertinib as first-line treatment in NSCLC patients with common EGFR mutations.

METHODS: A budget impact analysis was conducted from a Dutch healthcare perspective over a 5-year time horizon for treatment naïve patients with EGFR-mutant NSCLC receiving afatinib versus osimertinib, followed by subsequent treatments. Costs were estimated using a decision analytic model constructed in Excel. Time on treatment spent by patients in a progression-free disease state was based on simulated progression free survival data from clinical trials and a network meta-analysis. Scenario analyses, and one-way sensitivity analysis was used to test the models robustness.

RESULTS: Sequential treatment with first-line afatinib showed mean total time on treatment (ToT) of 29.1 months, quality-adjusted life months (QALMs) of 20.2 with mean cost of €108,166 per patient versus first-line osimertinib with mean total ToT of 24.7 months, QALM of 17.4 and mean cost per patient of €143,251. The total budget impact over five years was €110.4 million for the sequence starting with afatinib and €158.6 million for the sequence starting with osimertinib, leading to a total incremental cost of €48.15 million. Scenario analysis showed a similar trend. The results were most sensitive to the price of afatinib and osimertinib.

CONCLUSIONS: Afatinib as a first-line treatment approach in patients with EGFR mutation positive NSCLC would have a lower financial impact on the healthcare budget in the Netherlands with a higher mean ToT and QALM compared to a sequential treatment approach starting with osimertinib.