Vasilopoulos Angelos, Pohlman Alexander, Odeh Ayham, Shen K Robert, Coughlin Julia M, Abdelsattar Zaid M
Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois.
Department of Thoracic & CV Surgery, Loyola University Medical Center, Maywood, Illinois.
JTO Clin Res Rep. 2025 Apr 9;6(6):100833. doi: 10.1016/j.jtocrr.2025.100833. eCollection 2025 Jun.
Osimertinib is now approved as adjuvant therapy for stage IB to III NSCLC with mutations. Nevertheless, this treatment is lengthy and expensive. Its cost-effectiveness profile as monotherapy versus combination with chemotherapy is unknown. In this context, we investigate the cost-effectiveness of adjuvant osimertinib with and without chemotherapy for NSCLC.
A set of Markov models was established to predict the cost-effectiveness of these different regimens. Data were sourced from the ADAURA trial's publications and protocols. Health outcomes were quantified as quality-adjusted life-years (QALYs). Costs and incremental cost-effectiveness ratios (ICERs) were estimated in U.S. dollars (USD) and USD per QALY, respectively. Deterministic and probabilistic sensitivity analyses were performed. Data from the Surveillance, Epidemiology, and End Results Program were used to predict additional costs to the U.S. health care system.
Compared with treatment with chemotherapy alone, treatment with osimertinib plus chemotherapy yielded 5.86 QALYs with incremental costs of $414,607.69 (ICER = $380,347.85 per QALY). Treatment with osimertinib alone yielded 6.63 QALYs with an incremental cost of $402,224.32 (ICER = $213,447.59 per QALY). Osimertinib is only likely to be cost-effective if the willingness-to-pay threshold per QALY is $200,000 or more. The price of osimertinib had the strongest influence on cost-effectiveness. On the basis of Surveillance, Epidemiology, and End Results Program data, these practices may cost the U.S. health care system an additional 8.9 billion USD/year.
Adjuvant osimertinib alone is more cost-effective than combination therapy, but only if the willingness-to-pay is high. A reduction in the price of osimertinib would improve its cost-effectiveness profile.
奥希替尼现已被批准作为伴有特定突变的 IB 至 III 期非小细胞肺癌（NSCLC）的辅助治疗药物。然而，这种治疗疗程长且费用高昂。其作为单药治疗与联合化疗相比的成本效益情况尚不清楚。在此背景下，我们研究了奥希替尼辅助治疗联合或不联合化疗用于 NSCLC 的成本效益。
建立了一组马尔可夫模型来预测这些不同治疗方案的成本效益。数据来源于 ADAURA 试验的出版物和方案。健康结果以质量调整生命年（QALYs）进行量化。成本和增量成本效益比（ICERs）分别以美元（USD）和每 QALY 的美元数进行估算。进行了确定性和概率性敏感性分析。使用监测、流行病学和最终结果计划（Surveillance, Epidemiology, and End Results Program）的数据来预测美国医疗保健系统的额外成本。
与单纯化疗相比，奥希替尼联合化疗产生了 5.86 个 QALYs，增量成本为 414,607.69 美元（ICER = 每 QALY 380,347.85 美元）。单独使用奥希替尼产生了 6.63 个 QALYs，增量成本为 402,224.32 美元（ICER = 每 QALY 213,447.59 美元）。仅当每 QALY 的支付意愿阈值为 200,000 美元或更高时，奥希替尼才可能具有成本效益。奥希替尼的价格对成本效益影响最大。根据监测、流行病学和最终结果计划的数据，这些治疗方法可能使美国医疗保健系统每年额外花费 89 亿美元。
单独使用奥希替尼辅助治疗比联合治疗更具成本效益，但前提是支付意愿较高。降低奥希替尼的价格将改善其成本效益情况。
