Cost-effectiveness analysis of Amivantamab plus Lazertinib, Lazertinib versus Osimertinib in NSCLC with EGFR

Yueyun Li ¹ Liu Yuhang ¹ Hui Zhang ^1* Haonan Li ² Hong Wang ¹

• ¹ Guangdong Pharmaceutical University, Guangzhou, China
• ² School of Pharmaceutical Sciences, Peking University, Beijing, China, China

Background: Amivantamab plus lazertinib (amivantamab-lazertinib) has shown clinically meaningful and durable antitumor activity in patients with previously untreated or osimertinib-pretreated epidermal growth factor receptor (EGFR)-mutated advanced non-small-cell lung cancer (NSCLC). Objectives: This study evaluated the cost-effectiveness of amivantamab-lazertinib versus lazertinib versus osimertinib for patients with previously untreated or osimertinib-pretreated EGFR-mutated advanced NSCLC. Methods: Based on a phase III randomized, double-blind, multi-centre clinical trial comparing amivantamab plus lazertinib to osimertinib (NCT04487080) for the treatment of patients with previously untreated or osimertinib-pretreated EGFR-mutated advanced NSCLC. A Markov model was developed to simulate the progression of disease, with a model cycle of 3 weeks and a 5-year time range; the leading output indicators of the model were total cost, quality-adjusted life year (QALY), andincremental cost-effectiveness ratio (ICER); the cost and health output were discounted using 3.0% discount rate. Using 1~3 times China's per capita gross domestic product (GDP) (12,295.7~36,887.0 dollars) in 2023 as the willingness-to-pay (WTP) threshold, the cost-utility analysis method was used for analysis, both sensitivity analysis and scenario analysis were conducted to assess the robustness of the model. Results:Compared with osimertinib alone, amivantamab combined with lazertinib gained an incremental effectiveness of 1.11 QALYs and an incremental cost of $1,342,374.38, which resulted in an ICER of $1,211,235.50/QALY. The ICER was much higher than the WTP threshold of 36,887.0/QALY. Amivantamab gained an incremental effectiveness of 0.71 QALYs and an incremental cost of $224,248.17, which resulted in an ICER of $315,639.51/QALY. The ICER was much higher than the WTP threshold of 12,295.7/QALY. One-way sensitivity analysis revealed that durgs' costs were the leading influential factor in the model. Conclusions: Compared with osimertinib alone, amivantamab-lazertinib and lazertinib are not cost-effective first-line treatment choices for NSCLC patients with EGFR exon 20 insertions. The costly price of drugs is one of the primary reasons for the high cost of those treatment strategies. Therefore, it is imperative to consider the high cost of drugs in the subsequent clinical application and strive to attain a relative equilibrium between their significant clinical benefit and economic encumbrance.