Cost-Utility Analysis of Adjuvant Osimertinib in Resected Epidermal-Growth-Factor-Receptor-Mutated Early-Stage Non-Small Cell Lung Cancer

Abstract

Objectives Lung cancer is the most common cancer and the leading cause of cancer death worldwide. One-third of non-small cell lung cancer (NSCLC) patients are diagnosed at a resectable stage, for which surgery is the standard curative treatment. However, most patients recur within 2 years. Adjuvant osimertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, significantly reduces recurrence and prolongs survival in completely resected EGFR-mutated NSCLC. This study assessed the cost-utility and budget impact of adjuvant osimertinib versus placebo for resected stage IB-IIIA EGFR-mutated NSCLC from Thailand’s societal perspective. Methods A Markov model with a lifetime horizon and 4-week cycle was developed, including 3 health states: disease-free, recurrent disease, and death. Patients received osimertinib or placebo in the disease-free state, with recurrence categorized as locoregional or distant. Subsequent treatments were modeled based on recurrence timing. Health outcomes were obtained from a systematic review, and costs followed Thai health technology assessment guidelines. Results were reported as incremental cost-effectiveness ratios in 2023 USD per quality-adjusted life-years (QALY) gained. Sensitivity analyses addressed uncertainty. Results Osimertinib yielded 2.36 additional QALYs at an incremental cost of USD 62 604.90, with an incremental cost-effectiveness ratio of USD 26 474.02/QALY, exceeding Thailand’s willingness-to-pay threshold (USD 4619). An 85.07% price reduction is required for cost-effectiveness. Probabilistic sensitivity analysis showed 0% probability of cost-effectiveness at the current threshold, increasing to 52% at USD 25 981.97/QALY. The 5-year budget impact analysis was estimated at USD 678.73 million. Conclusions Adjuvant osimertinib is not cost-effective in Thailand under current pricing but could be with major price reductions or risk-sharing strategies.