Cost-effectiveness of osimertinib in the UK for advanced EGFR-T790M non-small cell lung cancer

Figures & data

Table 1. Non-parametric analysis, unadjusted and adjusted.

Outcome	AURA pooled	IMPRESS T790M mutation-positive	Treatment effect, HR (95% CI; p-value)
Indication	Second-line	Second-line	–
Treatment	Osimertinib	PDC	–
Adjusted indirect comparison
PFS adjusted
Number of patients, n	92	53	0.242 (0.148–0.394; p < .0001)
Total events, n (%)	51 (55.4)	41 (77.4)
Months, median	10.9	5.3
OS adjusted
Number of patients, n	92	53	0.347 (0.179–0.673; p = .0016)
Total events, n (%)	17 (18.5)	38 (71.7)
Months, median	Not reached	14.1
Unadjusted indirect comparison
PFS unadjusted
Number of patients, n	127	61	0.234 (0.155–0.356; p < .001)
Total events, n (%)	69 (54.3)	48 (78.7)
Months, median (95% CI)	11.0 (8.3–13.6)	5.3 (4.0–5.6)
OS unadjusted
Number of patients, n	129	61	0.357 (0.209–0.611; p < .001)
Total events, n (%)	25 (19.4)	44 (72.1)
Months, median (95% CI)	Not reached	14.1 (11.0–20.5)

CI, confidence interval; HR, hazard ratio; OS, overall survival; PDC, platinum-based doublet chemotherapy; PFS, progression-free survival.

Figure 1. Overall survival and progression-free survival in the base case (adjusted analysis).

Table 2. Costs of T790M testing, disease management, and treatment.

	Cost, £
	Osimertinib	PDC
T790M testing (per patient identified as eligible for osimertinib)	1,350.80	0
Progression-free (per week)	77.44	77.44
Progressed disease (per week)	139.58	139.58
End-of-life/terminal care (one-off)	3,905.35	3,905.35
Drug acquisition costs (list price per pack)	5,770	160.00
Drug administration costs (per administration)	0.48	First: 245.16 Subsequent: 332.50
Drug monitoring costs (per week)	0	4.61

PDC, platinum-based doublet chemotherapy.

Table 3. Results of scenario analyses.

Scenario	Total cost, £		Total QALYs		Incremental costs, £	Incremental QALYs	ICER, £/QALY gained
	Osimertinib	PDC	Osimertinib	PDC
Base case	87,441	23,159	2.841	1.300	64,283	1.541	41,705
(a) Survival modeling
PFS and OS distribution: Weibull (both arms)	86,975	23,239	2.848	1.300	63,736	1.548	41,173
PFS and OS distribution: log logistic (both arms)	93,784	23,390	3.765	1.356	70,393	2.409	29,224
PFS and OS distribution: exponential (both arms)	91,819	23,587	3.510	1.442	68,231	2.068	32,993
(b) Health State Utility Values
(i) AURA2 EQ-5D-5L Crosswalk Values
No Treatment Response: PF 0.812 (both arms); PD 0.751 (both arms)	87,441	23,159	2.952	1.365	64,283	1.587	40,510
Treatment Response: PF 0.808 (Osimertinib); PF 0.781 (PDC); PD 0.751 (both arms)	87,441	23,159	2.947	1.352	64,283	1.595	40,313
(ii) AURA2 EQ-5D-5L England Valuation Set Values
No Treatment Response: PF 0.874 (both arms); PD 0.821 (both arms)	87,441	23,159	3.214	1.490	64,283	1.724	37,279
Treatment Response: PF 0.870 (Osimertinib); PF 0.848 (PDC); PD 0.821 (both arms)	87,441	23,159	3.210	1.479	64,283	1.731	37,145
(iii) IMPRESS EQ-5D-3L Index Values
No Treatment Response: PF 0.779 (both arms); PD 0.679 (both arms)	87,441	23,159	2.712	1.249	64,283	1.463	43,928

ICER, incremental cost-effectiveness ratio; OS, overall survival; PD, progressed disease; PDC, platinum-based doublet chemotherapy; PF, progression-free; PFS, progression-free survival; QALY, quality-adjusted life-years.

Figure 2. Cost-effectiveness acceptability curve including osimertinib and PDC.