Estimating the Real Option Value of Osimertinib Compared to Standard EGFR-TKI in the Treatment of Advanced NSCLC in the United States.

BACKGROUND AND

objectiveReal option value (ROV) remains underexplored in epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) for non-small cell lung cancer (NSCLC) even though its impact on economic evaluation is being acknowledged. The objective of this study is to estimate the ROV of osimertinib compared with gefitinib/erlotinib in the treatment of advanced NSCLC.

methodsThe ROV was estimated using a three-state Markov model comprising progression-free survival, progressed, and death. The trend approach using NSCLC patients from Surveillance, Epidemiology, and End Results (SEER), and Medicare data, diagnosed between 2011 and 2017, was used. Cox proportional hazards models were fitted in the first 3 years of diagnosis. We assumed that historical survival trends continued beyond 2017 to estimate post-2017 the lung cancer-specific hazard ratio. The estimated hazard ratio was then applied to the transition probabilities from the progressed disease to death to estimate costs and quality-adjusted life years (QALYs), accounting for future improvements in survival. A cycle length of 1 month and a lifetime horizon was used in the analysis. The analysis was conducted from the US health system's perspective and a discount rate of 3% annually was applied.

resultsThe hazard ratios for all-cause mortality, lung cancer-specific mortality, and other-cause mortality were: 0.835 (95% CI 0.827-0.843; p < 0.001), 0.832 (95% CI 0.824-0.840; p < 0.001), and 0.870 (95% CI 0.841-0.900; p < 0.001), respectively. In the ROV scenario, the incremental cost of osimertinib versus standard EGFR-TKI decreased by 4.40%, from $239,779.95 to $229,226.80. The incremental life years (LYs) and QALYs rose from 1.931 and 1.52 in the conventional setting, to 2.67 and 2.05, respectively. This resulted in 38.34% and 34.86% increase, respectively, from the conventional scenario. The incremental cost effectiveness ratio (ICER) decreased by 29.04% from $157,761.26/QALY in the conventional to $111,942.31/QALY in the option value scenario.

conclusionThis study demonstrates that incorporating ROV into the conventional cost-effectiveness analysis of osimertinib versus standard EGFR-TKI provides a more comprehensive assessment of its value and cost effectiveness. This helps decision-makers better understand the long-term value of first-line treatment choices in advanced EGFR-mutated NSCLC.