Pharmacoeconomic Analysis of Osimertinib Compared to Earlier-Generation EGFR Inhibitors in EGFR-Mutated NSCLC: A Systematic Review.

چکیده اصلی

BACKGROUND: Osimertinib has reshaped the treatment of EGFR-mutated non-small cell lung cancer (NSCLC), but its high cost raises persistent questions about value for money. OBJECTIVES: To review economic evaluations of osimertinib in EGFR-mutated NSCLC and identify the drivers of cost-effectiveness across first-line, second-line/sequential, and adjuvant settings in North America and Europe. METHODS: This review was registered with PROSPERO (CRD420251139947) and conducted in accordance with PRISMA 2020. We searched PubMed/MEDLINE, Embase, Web of Science Core Collection, and the Cochrane Library through August 2025 for peer-reviewed economic evaluations comparing osimertinib with chemotherapy or earlier-generation EGFR tyrosine kinase inhibitors from a payer perspective. Reporting quality was appraised with CHEERS 2022. Given heterogeneity in models, pricing, and survival extrapolation, results were synthesized narratively, each incremental cost-effectiveness ratio (ICER) interpreted against its own jurisdiction's willingness-to-pay (WTP) threshold. RESULTS: Nine studies published between 2018 and 2024 were included. First-line osimertinib improved outcomes but at ICERs of $151,922-$231,123/QALY (US) and €128,343-€273,895/QALY (Europe), exceeding local thresholds. Second-line T790M-positive estimates were favorable and context-dependent ($159,126/QALY US; £41,705/QALY UK under end-of-life criteria). Adjuvant results were most divergent: cost-effective under cure-fraction assumptions but unfavorable when benefit was modeled as delayed recurrence. Price, overall-survival (OS) extrapolation, sequencing, and local WTP thresholds were dominant. CONCLUSIONS: Osimertinib confers meaningful clinical benefit, but its value for money is context-specific and often uncertain at current list prices. These conclusions rest on few heterogeneous models and warrant caution; sustainable use will depend on price reductions, patient prioritization, maturation of OS data, and outcome-based reimbursement.

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