(126) Title: Cost-Effectiveness of Osimertinib for Consolidation in EGFR-Mutated Stage III NSCLC

Background: : Osimertinib has become the preferred treatment for non-small-cell lung cancer (NSCLC) with specific epidermal growth factor receptor (EGFR) mutations. Results have shown that osimertinib significantly prolongs progression-free survival (PFS) compared to placebo in patients with unresectable stage III EGFR-mutated NSCLC following definitive chemoradiotherapy (CRT). While osimertinib demonstrates strong clinical efficacy, its cost-effectiveness remains uncertain.

Objective: : To assess the cost-effectiveness of osimertinib as consolidation therapy following CRT for Stage III EGFR-mutated NSCLC.

Methods: : A partitioned survival model (PSM) was developed using clinical efficacy data extracted from the LAURA trial. Individual patient-level data were reconstructed from published Kaplan-Meier curves for both PFS and overall survival (OS). Cost data were obtained from the Red Book database, and the model compared osimertinib to placebo from a U.S. healthcare payer perspective. Effectiveness was measured in Quality-Adjusted Life Years (QALYs). Utility values used to calculate QALYs were obtained from literature reviews. Both costs and QALYs were discounted at an annual rate of 3%. The incremental cost-effectiveness ratio (ICER) was calculated to determine cost-effectiveness by comparing against a willingness-to-pay (WTP) threshold of $150,000. Sensitivity analyses were conducted to assess the robustness of results. All analyses were performed in R.

Results: : The base-case analysis showed that osimertinib resulted in an incremental cost of $361,995 and an incremental QALY of 0.401 compared to placebo, yielding an ICER of $903,779 per QALY gained. Compared to the threshold of $150,000, the osimertinib was not cost-effective as a consolidation treatment for stage III EGFR-mutated NSCLC. Sensitivity analyses demonstrated minimal variability in ICER outcomes, indicating a low degree of model uncertainty.

Conclusions: : At commonly accepted U.S. WTP thresholds, osimertinib is not a cost-effective option for consolidation therapy in patients with stage III EGFR-mutated NSCLC following CRT. While the clinical benefits observed in the LAURA trial are substantial, the high incremental cost limits its economic value in current U.S. practice. These findings highlight a growing disconnect between clinical innovation and affordability, underscoring the need for better alignment between drug cost and health gains.

Sponsorship:: None