OBJECTIVES

: Lung cancer is the most common cancer and the leading cause of cancer death worldwide, of which approximately 80% are non-small-cell lung cancer (NSCLC). Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor (EGFR-TKIs) are recommended as first-line treatment for patients with EGFR mutation–positive advanced NSCLC.. Preclinical trails suggest that osimertinib may also be an effective first-line therapy. The phase 3 FLAURA trial demonstrated the efficacy and safety of osimertinib in untreated EGFR-mutated advanced NSCLC.The study was aimed to evaluate the cost-effectiveness of osimertinib versus the standard EGFR-TKIs in patients with previously untreated, EGFR mutation–positive advanced NSCLC.

METHODS

: A three-state Markov model was used to estimate the incremental cost-effectiveness ratio (ICER) of osimertinib versus the standard EGFR-TKIs. The states were: progression-free survival, progressive disease and death. The model was developed from a Chinese payer perspective. The robustness of the results was checked with sensitivity analyses.

RESULTS

: Compared with the standard EGFR-TKIs, osimertinib was estimated to increase the cost by $192522.428, with a gain of 0.835 QALYs, resulting in an ICER of $230565.782 per QALY. The ICER also exceeded commonly accepted willingness-to-pay threshold ($25749.00 per QALY). Duration of the PFS state for the osimertinib group and the cost for osimertinib played the most critical role on the ICER.

CONCLUSIONS

: Osimertinib is not a cost-effective treatment option for untreated EGFR mutation–positive advanced NSCLC in China. Cost reductions in osimertinib result in dramatic declines in the ICER suggesting that reducing the cost of osimertinib by reimbursement and donation would alters its affordability.