OBJECTIVES

: This study aimed to estimate the cost-effectiveness of the irreversible third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) osimertinib compared to standard TKI (gefitinib, erlotinib, or afatinib) in patients with non-small cell lung cancer (NSCLC) harbouring EGFR mutations in the Netherlands.

METHODS: A systematic review and network meta-analysis (NMA) were conducted to estimate the relative efficacy of osimertinib compared to gefitinib, erlotinib, and afatinib in EGFR-mutated NSCLC. To assess the cost-effectiveness of osimertinib, a Markov model was developed from a Dutch societal perspective. The model was based on the clinical studies included in the NMA. Incremental costs per life-year (LY) and per quality-adjusted life-year (QALY) gained were estimated. Sensitivity analyses were conducted to test the robustness of the model and the uncertainty within parameters.

RESULTS: The NMA showed a significantly better PFS and OS for osimertinib compared to gefitinib, erlotinib, and afatinib. Total discounted per patient costs for gefitinib, erlotinib, afatinib, and osimertinib were €51,580, €50,039, €55,074, and €137,737 and mean QALYs were 1.37, 1.40, 1.53, and 2.01 per patient, respectively. Osimertinib compared to gefitinib resulted in a cost-effectiveness ratio of €131,842/QALY and €92,208/LY gained. Relative to erlotinib, osimertinib yielded incremental costs of €140,116/QALY and €97,484/LY gained. Osimertinib resulted in €168,117/QALY and €118,536/LY gained compared to afatinib. Considering a Dutch threshold of €80,000/QALY, the probability of being cost-effective for osimertinib is about 5%. A price reduction of osimertinib of 41% is required for osimertinib to be cost-effective at a threshold of €80,000/QALY.

CONCLUSIONS: Osimertinib was the most favourable treatment option in terms of efficacy compared to gefitinib, erlotinib, and afatinib. However, treatment costs related to osimertinib are substantially higher than all other TKIs. At a threshold of €80,000/QALY, osimertinib appears not to be cost-effective compared to standard TKI.