Cost-effectiveness analysis of amivantamab plus chemotherapy for non-small cell lung cancer patients with epidermal growth factor receptor exon 20 insertions in the United States

• Published in: International journal of clinical pharmacy 2024-12, Vol.46 (6), p.1335-1344
• Main Authors: Cao, Yingdan, Yi, Hongbin, Shi, Fenghao, Wei, Xiaoxia, Han, Sheng
• Format: Article
• Language: English
• Subjects: Cancer; Chemotherapy; Cost analysis; Cost benefit analysis; Economic aspects; Epidermal growth factor; Epidermal growth factor receptors; Internal Medicine; Lung cancer; Lung cancer, Non-small cell; Lung cancer, Small cell; Medicaid; Medicine; Medicine & Public Health; Monoclonal antibodies; Non-small cell lung carcinoma; Patients; Pemetrexed; Pharmacy; Research Article; Sensitivity analysis; Small cell lung carcinoma; Targeted cancer therapy
• ISSN: 2210-7703; 2210-7711; 2210-7711
• DOI: 10.1007/s11096-024-01761-7

Background Although amivantamab has shown clinical benefits for non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) exon 20 insertions, its cost-effectiveness requires further investigation. Aim To evaluate the cost-effectiveness of amivantamab plus chemotherapy for the treatment of NSCLC patients with EGFR exon 20 insertions from the United States payer perspective. Method A partitioned survival model was developed based on the data from the PAPILLON trial. Costs were derived from the pricing files of Medicare and Medicaid Services and published literature, and utility values were derived from previous studies. A 3% annual discount rate was applied to both costs and outcomes. The primary outcome was the incremental cost-effectiveness ratio (ICER). One-way sensitivity analysis, probabilistic sensitivity analysis and scenario analysis, were conducted to test the model stability. Results Amivantamab plus chemotherapy yielded an additional 1.12 quality-adjusted life years (QALYs) while increasing costs by $483,769.50 relative to the chemotherapy regimen, leading to an ICER of $432,401.16/QALY. The combination of amivantamab with chemotherapy was not cost effective at a threshold of $150,000/QALY. In the scenario analysis, the results showed that the ICERs were $263,680.69/QALY and $418,416.35/QALY when different utility values and 10-year time horizons were adopted, respectively. For PSA, the probability that amivantamab plus chemotherapy would be cost-effective was 0% if the willingness-to-pay (WTP) threshold was $150,000/QALY. Conclusion Amivantamab plus chemotherapy is unlikely to be a cost-effective option for NSCLC patients with EGFR exon 20 insertions. Reducing the cost of amivantamab may produce favorable economic outcomes.