OBJECTIVES

To estimate the budget impact of afatinib vs. osimertinib in the first-line treatment of patients with EGFR common mutation (L858R and Del19) positive non-small-cell lung cancer (NSCLC). The model compared two treatment strategies: first-line afatinib followed by second-line osimertinib (T790M positive on progression) or chemotherapy (T790M negative on progression) followed by third-line chemotherapy versus first-line treatment osimertinib followed by second-line chemotherapy.

METHODS

The treatment costs and budget impact of these two alternatives were calculated at patient and China healthcare system’s level, respectively using an existing decision-tree model constructed in Microsoft Excel. The China-specific epidemiology (i.e., number of patients with EGFR M+ NSCLC), cost (including prices of afatinib, osimertinib, and chemotherapies, and costs of adverse events and T790M mutation tests), and clinical data (such as rates of adverse events and proportion of T790M mutation) were inputted in the model. The total time on treatment (ToT) was also simulated and measured. One-way sensitivity analysis (OWSA) was conducted to examine the robustness of this budget impact analysis.

RESULTS

Sequential treatment with afatinib versus first-line treatment with osimertinib showed mean total ToT of 29.7 months versus 26.0 months (3.6 months’ increase) with mean cost of CNY235,291 per patient versus CNY333,641 (CNY98,350 saved) per patient, respectively. The 5-year total budget impact was CNY37.1 billion for the afatinib sequence versus CNY57.1 billion for the osimertinib sequence. The accumulated cost savings in five years were CNY20 billion. OWSA showed that the prices of afatinib and osimertinib had a high impact on the budget impact results. OWSA also showed the budget impact analysis was robust.

CONCLUSIONS

The first-line use of afatinib saved costs and increased ToT compared to the first-line use of osimertinib in patients with EGFR M+ NSCLC in China.