Estimated Cost of Adverse Event Management in Treatment Naïve Non-small Cell Lung Cancer Patients with Common EGFR Mutations Treated with Amivantamab Plus Lazertinib and Osimertinib Plus Chemotherapy.

BACKGROUND: Recent clinical trials have demonstrated improved efficacy of combination regimens, including amivantamab plus lazertinib and osimertinib plus platinum-based chemotherapy, compared with standard therapy in patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC). As these regimens enter routine clinical use, understanding the economic implications of treatment-related adverse event (AE) management, including proactive therapy management (PTM), is important.

OBJECTIVES: To estimate and compare grade 3 or 4 AE management costs associated with first-line amivantamab (intravenous [IV] or subcutaneous [SC]) plus lazertinib and osimertinib plus platinum-based chemotherapy in patients with EGFR-mutated locally advanced or metastatic NSCLC from a US Commercial and Medicare Advantage payer perspective.

METHODS: A descriptive cost modeling analysis used grade 3/4 AE incidence data from pivotal clinical trials of amivantamab (IV and SC) plus lazertinib and osimertinib plus platinum-based chemotherapy. AEs occurring in ≥5% of patients or deemed clinically significant were included. PTM strategies for dermatologic events, venous thromboembolism, and infusion-related reactions were modeled for amivantamab-based regimens using guideline-concordant practices and clinical trial evidence. As a conservative assumption, PTM for osimertinib plus platinum-based chemotherapy was not included. AE management costs were derived from national inpatient and physician fee schedules and inflated to 2025 US dollars. Total per-patient AE management and PTM costs were estimated for each treatment regimen. Scenario analyses evaluated expanded PTM assumptions.

RESULTS: Across both payer perspectives, total AE management costs were estimated to be lower for amivantamab-based regimens than for osimertinib plus platinum-based chemotherapy. Under the Commercial perspective, modeled AE management costs were 2345 f o r a m i v a n t a m a b ( S C ) p l u s l a z e r t i n i b , 4321 for amivantamab (IV) plus lazertinib, and 8497 f o r o s i m e r t i n i b p l u s p l a t i n u m - b a s e d c h e m o t h e r a p y . C o r r e s p o n d i n g M e d i c a r e A d v a n t a g e e s t i m a t e s w e r e 1166, 2425 , a n d 4185, respectively. Inclusion of PTM costs did not alter the relative cost ranking calculated and findings were consistent across scenario analyses.

CONCLUSIONS: Results from this descriptive cross-trial analysis indicated that total AE management costs were consistently estimated to be lower in patients receiving amivantamab (SC or IV) plus lazertinib compared with osimertinib plus platinum-based chemotherapy across both a Commercial and Medicare Advantage payer perspective.