OBJECTIVES : To compare the cost-effectiveness of osimertinib and platinum-based double chemotherapy in treating NSCLC patients who failed in front line EGFR TKI treatment.

METHODS : From the healthcare system’s perspective, using dynamic Markov modelling, 3-week per cycle, to simulate lifetime direct medical costs and QALYs. Two scenarios were set: all patients and T790M confirmed positive patients progressed after EGFR-TKI. The treatment group, in scenario 1, if T790M+, was treated with osimertinib, otherwise chemotherapy; in scenario 2 was treated with osimertinib. The control groups were treated with chemotherapy in both scenarios. Clinical data were sourced from clinical trials-AURA extension&2, 3 and IMPRESS. Utility and cost data were sourced from latest published literature, considering patient assistance program. Costs included T790M tests, pharmaceutical acquisition, follow-up, adverse event treatment, best supportive and terminal care. One way sensitivity analysis and probabilistic sensitivity analysis were conducted.

RESULTS : For all patients progressed after EGFR-TKI, the treatment group yielded an additional 0.40 QALYs (1.87vs1.47), 0.5 LYs (2.51vs2.01) and RMB107,352 (303,830vs196,478). For T790M + patients, the difference was 0.68 QALYs (1.89vs1.21), 0.88 LYs (2.52vs1.64) with an additional cost of RMB163,168 (349,853vs186,685). The ICERs were RMB269,618/QALY and 239,076/QALY, respectively. Both ICERs were higher than WHO suggested threshold at the national level of 2016, but lower than that of some provinces such as Beijing, Shanghai and Jiangsu, etc. The sensitivity analysis showed the results were robust.

CONCLUSIONS : Osimertinib can prolong survival and improve quality of life, and is likely to be cost-effective in many areas of China. While the results should be updated along with the changes of the price of osimertinib, PAP and clinical trials data in the future.