Cost-Effectiveness of Adjuvant Osimertinib With and Without Chemotherapy for Surgically Resected NSCLC
Introduction: Osimertinib is now approved as adjuvant therapy for stage IB to III NSCLC with EGFR mutations. Nevertheless, this treatment is lengthy and expensive. Its cost-effectiveness profile as monotherapy versus combination with chemotherapy is unknown. In this context, we investigate the cost-...
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Elsevier
2025-06-01
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| Series: | JTO Clinical and Research Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666364325000499 |
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| author | Angelos Vasilopoulos, BS Alexander Pohlman, MD Ayham Odeh, MD K. Robert Shen, MD Julia M. Coughlin, MD Zaid M. Abdelsattar, MD, MS, FACS |
| author_facet | Angelos Vasilopoulos, BS Alexander Pohlman, MD Ayham Odeh, MD K. Robert Shen, MD Julia M. Coughlin, MD Zaid M. Abdelsattar, MD, MS, FACS |
| author_sort | Angelos Vasilopoulos, BS |
| collection | DOAJ |
| description | Introduction: Osimertinib is now approved as adjuvant therapy for stage IB to III NSCLC with EGFR mutations. Nevertheless, this treatment is lengthy and expensive. Its cost-effectiveness profile as monotherapy versus combination with chemotherapy is unknown. In this context, we investigate the cost-effectiveness of adjuvant osimertinib with and without chemotherapy for NSCLC. Methods: A set of Markov models was established to predict the cost-effectiveness of these different regimens. Data were sourced from the ADAURA trial’s publications and protocols. Health outcomes were quantified as quality-adjusted life-years (QALYs). Costs and incremental cost-effectiveness ratios (ICERs) were estimated in U.S. dollars (USD) and USD per QALY, respectively. Deterministic and probabilistic sensitivity analyses were performed. Data from the Surveillance, Epidemiology, and End Results Program were used to predict additional costs to the U.S. health care system. Results: Compared with treatment with chemotherapy alone, treatment with osimertinib plus chemotherapy yielded 5.86 QALYs with incremental costs of $414,607.69 (ICER = $380,347.85 per QALY). Treatment with osimertinib alone yielded 6.63 QALYs with an incremental cost of $402,224.32 (ICER = $213,447.59 per QALY). Osimertinib is only likely to be cost-effective if the willingness-to-pay threshold per QALY is $200,000 or more. The price of osimertinib had the strongest influence on cost-effectiveness. On the basis of Surveillance, Epidemiology, and End Results Program data, these practices may cost the U.S. health care system an additional 8.9 billion USD/year. Conclusions: Adjuvant osimertinib alone is more cost-effective than combination therapy, but only if the willingness-to-pay is high. A reduction in the price of osimertinib would improve its cost-effectiveness profile. |
| format | Article |
| id | doaj-art-a3dfb7cd1bf6467a9ff031fbb219a37a |
| institution | DOAJ |
| issn | 2666-3643 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTO Clinical and Research Reports |
| spelling | doaj-art-a3dfb7cd1bf6467a9ff031fbb219a37a2025-08-20T03:07:51ZengElsevierJTO Clinical and Research Reports2666-36432025-06-016610083310.1016/j.jtocrr.2025.100833Cost-Effectiveness of Adjuvant Osimertinib With and Without Chemotherapy for Surgically Resected NSCLCAngelos Vasilopoulos, BS0Alexander Pohlman, MD1Ayham Odeh, MD2K. Robert Shen, MD3Julia M. Coughlin, MD4Zaid M. Abdelsattar, MD, MS, FACS5Stritch School of Medicine, Loyola University Chicago, Chicago, IllinoisStritch School of Medicine, Loyola University Chicago, Chicago, Illinois; Department of Thoracic & CV Surgery, Loyola University Medical Center, Maywood, Illinois; Department of Surgery, University of Illinois at Chicago, Chicago, IllinoisStritch School of Medicine, Loyola University Chicago, Chicago, Illinois; Department of Thoracic & CV Surgery, Loyola University Medical Center, Maywood, IllinoisDepartment of Surgery, Mayo Clinic, Rochester, MinnesotaStritch School of Medicine, Loyola University Chicago, Chicago, Illinois; Department of Thoracic & CV Surgery, Loyola University Medical Center, Maywood, IllinoisStritch School of Medicine, Loyola University Chicago, Chicago, Illinois; Department of Thoracic & CV Surgery, Loyola University Medical Center, Maywood, Illinois; Department of Surgery, Edward Hines Jr. Medical Center, US Department of Veterans Affairs, Hines, Illinois; Corresponding author. Address for correspondence: Zaid M. Abdelsattar, MD, MS, FACS. Department of Thoracic and CV Surgery, Loyola Univeristy Chicago, 2160 S First Avenue, Maywood, Illinois 60153.Introduction: Osimertinib is now approved as adjuvant therapy for stage IB to III NSCLC with EGFR mutations. Nevertheless, this treatment is lengthy and expensive. Its cost-effectiveness profile as monotherapy versus combination with chemotherapy is unknown. In this context, we investigate the cost-effectiveness of adjuvant osimertinib with and without chemotherapy for NSCLC. Methods: A set of Markov models was established to predict the cost-effectiveness of these different regimens. Data were sourced from the ADAURA trial’s publications and protocols. Health outcomes were quantified as quality-adjusted life-years (QALYs). Costs and incremental cost-effectiveness ratios (ICERs) were estimated in U.S. dollars (USD) and USD per QALY, respectively. Deterministic and probabilistic sensitivity analyses were performed. Data from the Surveillance, Epidemiology, and End Results Program were used to predict additional costs to the U.S. health care system. Results: Compared with treatment with chemotherapy alone, treatment with osimertinib plus chemotherapy yielded 5.86 QALYs with incremental costs of $414,607.69 (ICER = $380,347.85 per QALY). Treatment with osimertinib alone yielded 6.63 QALYs with an incremental cost of $402,224.32 (ICER = $213,447.59 per QALY). Osimertinib is only likely to be cost-effective if the willingness-to-pay threshold per QALY is $200,000 or more. The price of osimertinib had the strongest influence on cost-effectiveness. On the basis of Surveillance, Epidemiology, and End Results Program data, these practices may cost the U.S. health care system an additional 8.9 billion USD/year. Conclusions: Adjuvant osimertinib alone is more cost-effective than combination therapy, but only if the willingness-to-pay is high. A reduction in the price of osimertinib would improve its cost-effectiveness profile.http://www.sciencedirect.com/science/article/pii/S2666364325000499Lung cancerTargeted therapyEGFROsimertinibCost-effectiveness |
| spellingShingle | Angelos Vasilopoulos, BS Alexander Pohlman, MD Ayham Odeh, MD K. Robert Shen, MD Julia M. Coughlin, MD Zaid M. Abdelsattar, MD, MS, FACS Cost-Effectiveness of Adjuvant Osimertinib With and Without Chemotherapy for Surgically Resected NSCLC JTO Clinical and Research Reports Lung cancer Targeted therapy EGFR Osimertinib Cost-effectiveness |
| title | Cost-Effectiveness of Adjuvant Osimertinib With and Without Chemotherapy for Surgically Resected NSCLC |
| title_full | Cost-Effectiveness of Adjuvant Osimertinib With and Without Chemotherapy for Surgically Resected NSCLC |
| title_fullStr | Cost-Effectiveness of Adjuvant Osimertinib With and Without Chemotherapy for Surgically Resected NSCLC |
| title_full_unstemmed | Cost-Effectiveness of Adjuvant Osimertinib With and Without Chemotherapy for Surgically Resected NSCLC |
| title_short | Cost-Effectiveness of Adjuvant Osimertinib With and Without Chemotherapy for Surgically Resected NSCLC |
| title_sort | cost effectiveness of adjuvant osimertinib with and without chemotherapy for surgically resected nsclc |
| topic | Lung cancer Targeted therapy EGFR Osimertinib Cost-effectiveness |
| url | http://www.sciencedirect.com/science/article/pii/S2666364325000499 |
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