Abstract
The aim of this analysis is to estimate the cost effectiveness of Osimertinib versus standard chemotherapy for patients with non-small cell lung cancer (NSCLC) with epidermal growth factor and 790m mutation who have failed to first line tirosin-kinase inhibitor treatment. A partitioned cohort model with 3 health states (Pre progression, progression and death) was adapted in order to represent the natural evolution of the disease. Estimates of resource usage and costs were performed from the perspective of public payer. Expected costs were measured in Chilean pesos (1 USD = 650 CLP) and benefits in quality adjusted life years (QALYs). Health related quality of life was estimated from AURA-3 trial study. A lifetime time horizon was used, and a 3% discount rate was considered for costs and outcomes. A probabilistic sensitivity analyses was performed to account for uncertainty. The total expected costs of treating NSCLC with Osimertinib are higher than standard chemotherapy (USD122,500 and USD13,000 respectively). Similarly, the expected incremental health benefit is higher in Osimertinib group (1.07 incremental QALYs). The base case scenario (current market prices for all treatments) shows an average ICER of Osimertinib versus standard chemotherapy of USD 101,777/QALY. The ICER is reduced to USD 78,206/QALY when the base price of Osimertinib is reduced a 25%. Both ICERs are above the cost effectiveness threshold range suggested by WHO of 1 to 3 GDPs per capita (USD15,000 to USD45,000). Deterministic sensitivity analysis shows a high impact of the price of treatment as a driver for incremental cost-effectiveness ratio. Osimertinib delivers high gains in life years and quality adjusted life years in comparison with standard chemotherapy. Higher costs driven by the price of the intervention under analysis should be a matter of negotiation in order to provide financial coverage to Chilean population.
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