Therapeutic advances in medical oncology · 2026
Cost-effectiveness of first-line osimertinib plus chemotherapy versus amivantamab plus lazertinib for advanced EGFR-mutant NSCLC in the US and China.
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Guo Yihong, Liu Shixian, Yang Chuang, Wang Chengjun, Zhang Rongyu, Wang Yunfei, Song Yanan, Liu Mingfei, Zhang Ruolin, Xuan Tiantian, Zhao Wen, Li Jisheng
Аннотация
BACKGROUND: The FLAURA2 and MARIPOSA trials established survival benefits of osimertinib plus chemotherapy and amivantamab plus lazertinib, respectively, over osimertinib monotherapy in advanced non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) sensitizing mutation.
OBJECTIVES: This study aimed to evaluate the cost-effectiveness of osimertinib plus chemotherapy versus amivantamab plus lazertinib from the US and Chinese healthcare perspectives.
DESIGN: An economic evaluation.
METHODS: A partitioned survival model with 28-day cycles was developed to simulate total costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) over a 10-year time horizon. Clinical efficacy and safety inputs were derived from FLAURA2 and MARIPOSA. Costs and utilities were sourced from public bid-winning databases, local charges, and published literature. A scenario analysis incorporated the amivantamab patient assistance program (PAP) in China. One-way and probabilistic sensitivity analyses (OWSA, PSA) assessed model uncertainty.
RESULTS: Compared with osimertinib monotherapy, the ICERs for osimertinib plus chemotherapy were $551,944/QALY (US) and $37,965/QALY (China). For amivantamab plus lazertinib, ICERs were $2,186,499/QALY (US) and $291,478/QALY (China). OWSA identified drug prices and utility values as key drivers. PSA indicated that in the US, osimertinib was cost-effective in 100% of simulations at a $150,000/QALY threshold. In China, at a $41,983.66/QALY threshold, osimertinib plus chemotherapy had a 74.10% probability of being cost-effective. The PAP scenario did not alter the conclusion for amivantamab plus lazertinib in China.
CONCLUSION: Based on indirect comparisons, osimertinib monotherapy is the cost-effective option for advanced EGFR-mutant NSCLC in the US. In China, osimertinib plus chemotherapy represents the optimal regimen given current pricing.
OBJECTIVES: This study aimed to evaluate the cost-effectiveness of osimertinib plus chemotherapy versus amivantamab plus lazertinib from the US and Chinese healthcare perspectives.
DESIGN: An economic evaluation.
METHODS: A partitioned survival model with 28-day cycles was developed to simulate total costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) over a 10-year time horizon. Clinical efficacy and safety inputs were derived from FLAURA2 and MARIPOSA. Costs and utilities were sourced from public bid-winning databases, local charges, and published literature. A scenario analysis incorporated the amivantamab patient assistance program (PAP) in China. One-way and probabilistic sensitivity analyses (OWSA, PSA) assessed model uncertainty.
RESULTS: Compared with osimertinib monotherapy, the ICERs for osimertinib plus chemotherapy were $551,944/QALY (US) and $37,965/QALY (China). For amivantamab plus lazertinib, ICERs were $2,186,499/QALY (US) and $291,478/QALY (China). OWSA identified drug prices and utility values as key drivers. PSA indicated that in the US, osimertinib was cost-effective in 100% of simulations at a $150,000/QALY threshold. In China, at a $41,983.66/QALY threshold, osimertinib plus chemotherapy had a 74.10% probability of being cost-effective. The PAP scenario did not alter the conclusion for amivantamab plus lazertinib in China.
CONCLUSION: Based on indirect comparisons, osimertinib monotherapy is the cost-effective option for advanced EGFR-mutant NSCLC in the US. In China, osimertinib plus chemotherapy represents the optimal regimen given current pricing.