Cost-effectiveness of amivantamab plus lazertinib and osimertinib plus chemotherapy versus osimertinib monotherapy for first-line EGFR-mutated advanced non-small cell lung cancer: an updated analysis.

Abstract

Introduction: Osimertinib, amivantamab plus lazertinib, and osimertinib plus chemotherapy are the recommended first-line treatment options for EGFR exon 19 deletion or exon 21 L858R-mutated non-small cell lung cancer (NSCLC). This study evaluated the cost-effectiveness of these options from a United States payer perspective.

Methods: A partitioned survival model compared the combination strategies to osimertinib monotherapy over a lifetime horizon, using clinical efficacy data from MARIPOSA and FLAURA2 trials. Direct medical costs and health state utilities were obtained from published sources. One-way and probabilistic sensitivity analyses assessed model robustness, using a willingness-to-pay threshold of $150,000 per quality-adjusted life year (QALY) or life year (LY) gained.

Results: Amivantamab plus lazertinib yielded higher total discounted costs ($1,219,207), QALYs (2.64), and LYs (3.80) compared with osimertinib monotherapy ($807,707; 2.10 QALYs; 3.00 LYs), with an incremental cost-effectiveness ratio (ICER) of $756,638/QALY in the MARIPOSA analysis. In the FLAURA2 analysis, osimertinib plus chemotherapy showed higher costs ($963,033), QALYs (2.81), and LYs (3.92) compared with osimertinib monotherapy ($662,520; 2.45 QALYs; 3.39 LYs), yielding an ICER of $829,930/QALY.

Conclusion: Neither combination strategy is cost-effective compared to osimertinib monotherapy for first-line EGFR-mutated advanced NSCLC from the US payer perspective.