An updated cost-effectiveness analysis of osimertinib versus placebo in resected EGFR-mutated non-small cell lung cancer: the perspective of the United States

The ADAURA trial reported a significant overall survival benefit of the use of adjuvant treatment with osimertinib following complete resection of stage IB‒IIIA non-small cell lung cancer (NSCLC) with epidermal gerowth factor receptor (EGFR) mutation. Herein, we aimed to strike an appropriate balance between osimertinib efficacy and cost in this patient population from the United States (US) healthcare system perspective. We used an exhaustive Markov model over a 30-year time horizon to analyze primary health outcomes such as incremental cost-effectiveness ratio (ICER), quality-adjusted life-years (QALYs), and life-years (LYs) with osimertinib adjuvant treatment in contrast to placebo in a group of patients with completely resected EGFR-mutated NSCLC at a willingness-to-pay of $150,000/QALY. Sensitivity analyses were performed to determine the model’s stability, together with subgroup analyses on the cohort. In comparison with placebo, osimertinib was associated with an enhancement effectiveness (cost) of 6.32 ($1,250,406) QALYs, which led to an ICER of $197,994 per QALY for the overall patient population. ICERs were consistently higher than $150,000/QALY. In the sensitivity analysis, cost of osimertinib and utility of disease progression mildly influenced ICER. The osimertinib regimen was not cost-effective in all subgroup analyses. In contrast to placebo, prolonged adjuvant osimertinib was not cost-effective in resected EGFR-mutated NSCLC patients in the US. However, it can provide more favorable health benefits.