Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA.
Oncologist. 2022 May 6;27(5):407-413. doi: 10.1093/oncolo/oyac021.
The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor osimertinib was recently approved for resected EGFR-mutant stages IB-IIIA non-small cell lung cancer due to improved disease-free survival (DFS) in this population compared with placebo. This study aimed to evaluate the cost-effectiveness (CE) of this strategy.
We constructed a Markov model using post-resection health state transitions with digitized DFS data from the ADAURA trial to compare cost and quality-adjusted life years (QALYs) of 3 years of adjuvant osimertinib versus placebo over a 10-year time horizon. An overall survival (OS) benefit of 5% was assumed. Costs and utility values were derived from Medicare reimbursement data and literature. A CE threshold of 3 times the gross domestic product per capita was used. Sensitivity analyses were performed.
The incremental cost-effectiveness ratio for adjuvant osimertinib was $317 119 per QALY-gained versus placebo. Initial costs of osimertinib are higher in years 1-3. Costs due to progressive disease (PD) are higher in the placebo group through the first 6.5 years. Average pre-PD, post-PD, and total costs were $2388, $379 047, and $502 937, respectively, in the placebo group, and $505 775, $255 638, and $800 697, respectively, in the osimertinib group. Sensitivity analysis of OS gains reaches CE with an hazard ratio (HR) of 0.70-0.75 benefit of osimertinib over placebo. A 50% discount to osimertinib drug cost yielded an ICER of $115 419.
Three-years of adjuvant osimertinib is CE if one is willing to pay $317 119 more per QALY-gained. Considerable OS benefit over placebo or other economic interventions will be needed to reach CE.
表皮生长因子受体（EGFR）酪氨酸激酶抑制剂奥希替尼因在该人群中改善了无病生存期（DFS），最近被批准用于切除的 EGFR 突变型 IB-IIIA 期非小细胞肺癌。本研究旨在评估该策略的成本效益（CE）。
我们使用 ADAURA 试验的DFS 数据构建了一个基于切除后健康状态转移的马尔可夫模型，以比较辅助奥希替尼与安慰剂在 10 年时间范围内 3 年的成本和质量调整生命年（QALY）。假设总生存（OS）获益为 5%。成本和效用值来自医疗保险报销数据和文献。使用人均国内生产总值的 3 倍作为 CE 阈值。进行了敏感性分析。
与安慰剂相比，辅助奥希替尼的增量成本效益比为每获得 1 个 QALY 增加 317119 美元。奥希替尼在第 1-3 年的初始成本较高。在安慰剂组中，在第 6.5 年之前，由于进行性疾病（PD）而导致的成本更高。在安慰剂组中，PD 前、PD 后和总费用分别为 2388 美元、379047 美元和 502937 美元，奥希替尼组分别为 505775 美元、255638 美元和 800697 美元。OS 获益的敏感性分析结果达到 CE，奥希替尼与安慰剂相比，HR 为 0.70-0.75，奥希替尼获益。奥希替尼药物成本降低 50%，ICER 为 115419 美元。
如果每获得一个 QALY 愿意多支付 317119 美元，那么辅助奥希替尼 3 年的治疗是具有成本效益的。需要奥希替尼与安慰剂或其他经济干预措施相比具有相当大的 OS 获益，才能达到 CE。
