OBJECTIVES: Epidermal Growth Factor Receptor - Tyrosine Kinase Inhibitor (EGFR-TKI) drugs are indicated for non-small cell lung cancer (NSCLC) with EGFR mutations. In this study we reviewed the recent works conducting economic evaluation of EGFR-TKI drugs.

METHODS: A systematic literature search was performed in MEDLINE, Embase and Cochrane Central databases. Only the studies on gefitinib, erlotinib, afatinib, osimertinib, dacomitinib or icotinib in NSCLC that performed cost effectiveness (CEA), cost benefit (CBA) or budget impact (BIA) analysis, and were published between 2014 to 2019 met the inclusion criteria.

RESULTS: Among total 168 retrieved articles 17 were duplicates, and 126 did not fulfill the inclusion criteria in abstract review. Out of remaining 25 studies 21 (19 CEA + 2 BIA) were selected for final synthesis after full text review. Among these 21 studies, 3 performed evaluation from only US health-system perspective, 3 from US and non-US perspective and 15 from only non-US perspective. From US payer’s perspective, one study found 1^st line erlotinib to be cost effective (ICER: $61,809 vs afatinib), and three studies found osimertinib to be not cost effective as either 1^st line (vs 1^st generation EGFR-TKIs) or 2^nd line (vs chemotherapy) treatment of NSCLC. The acquisition cost of osimertinib was identified as the major factor affecting CE in sensitivity analysis of all three studies. Two BIA analysis conducted from a US private health plan’s perspective found erlotinib and afatinib to increase a plan’s per person per month expenditure by $0.013 and $0.0001 respectively in the first year. Non-US studies provided varied results in respective context.

CONCLUSIONS: We found that relatively new EGFR-TKI osimertinib is not cost effective in US healthcare setting due to its high cost. Additionally, the estimated budget impact of several other EGFR-TKI drugs for US health plans was not substantial.