Cost-effectiveness of osimertinib in the treatment of advanced EGFR-mutated non-small cell lung cancer: a systematic review

ABSTRACT

Background

The most common type of lung cancer is advanced and mutant non-small cell lung cancer (NSCLC). Although targeted tyrosine kinase inhibitors (TKIs) have reconstructed the care of these patients, the resistance of TKIs to the secondary EGFR-T790M mutation in advanced or metastatic NSCLC led to the introduction of the third generation of them, like osimertinib. Osimertinib has represented a remarkable increase in progression-free survival (PFS) and a decrease in death and hazard ratios in patients with required T790 mutation and sensitizing EGFR mutation without T790M. We aimed to evaluate the cost-effectiveness of osimertinib for the treatment of these patients compared to chemotherapy or immunotherapy with the last generations of EGFR-TKIs.

Areas covered

Electronic searches were conducted on PubMed, Embase, Science Direct, Scopus, , Web of Knowledge, NHSEED, NHS Health Technology assessment (CRD), and Cost-Effectiveness Analysis Registry databases. Related articles were reviewed from January 2015 to the end of August 2020. Out of 2708 initial studies, 10 articles had the inclusion criteria.

Expert opinion

Although osimertinib improves the quality of life and PFS for the mentioned patients based on its greater efficacy compared to standard EGFR-TKIs and chemotherapy, its high cost prevents considering it a cost-effective option. And, since most entered studies have been done in developed countries, it certainly does not true to extend these results to low-income and developing countries. Therefore, further studies in those countries are needed to evaluate the cost-effectiveness of osimertinib for sensitizing EGFR mutation without T790M and required T790M in advanced or metastatic NSCLC.

KEYWORDS:

• Cost-effectiveness analysis
• osimertinib
• non-small cell lung cancer (NSCLC)
• T790M mutation
• systematic review

Article highlights

• Advanced EGFR-mutated NSCLC is one of the lung cancer types, and this cancer considered as the most common cause of death in the world due to its poor prognosis.

• The discovery of new therapeutic methods for treating advanced and sensitizing NSCLC-EGFR mutated like genetic modifications have ameliorated handling of this disease.

• the economic evaluation of these new interventions could provide appropriate circumstances for health policymakers to design suitable treatment sequences in this type of disease.

• Osimertinib has improved quality of life and increased progression-free survival in patients with advanced non-small-cell lung cancer and a mutation in the epidermal growth factor (mutated T790M).

• It seems that by reducing the price of osimertinib, its cost-effectiveness will increase.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interests

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Author contributions

All authors contributed to the conceptual background and content of the publication, and agreed for the final version of the manuscript to be published.

Additional information

Funding

This study was part of research project funded by the health management and economics research center affiliated to Iran University of Medical Sciences (Grant no: 98-3-48-16614 and ethical code: IR.IUMS.REC.1398.1069).