Osimertinib Cost-Effectiveness Falls Short of Payer Thresholds in First-Line EGFR+ NSCLC Use
Posted: Wednesday, August 26, 2026
Osimertinib Cost-Effectiveness Falls Short of Payer Thresholds in First-Line EGFR+ NSCLC Use
Upfront osimertinib delivered added survival benefit at a price that surpassed what payers in the United States and Europe are typically willing to spend, according to a systematic review published in Cancer Medicine. The economic review of osimertinib use in patients with EGFR-mutated non–small cell lung cancer was led by first author Nicola Perrotta, MD, of Policlinico Umberto I Hospital, Sapienza University, Rome, Italy.
The investigators queried PubMed/MEDLINE, Embase, Web of Science Core Collection, and the Cochrane Library through August 31, 2025. Eligible reports were peer-reviewed economic evaluations weighing osimertinib against chemotherapy or earlier-generation EGFR tyrosine kinase inhibitors from a payer standpoint in North America or Europe. Reporting quality was graded with the CHEERS 2022 checklist. Because the models varied too widely to pool, findings were described narratively, with every incremental cost-effectiveness ratio (ICER) judged against the spending threshold used in that country. Nine analyses issued between 2018 and 2024 qualified: four addressed initial therapy, two examined second-line or sequenced treatment, and three covered the adjuvant setting. Each relied on cost-utility modeling, typically partitioned-survival or Markov structures.
For initial therapy, the drug added between 0.19 and 0.59 quality-adjusted life-years (QALYs). U.S. ICERs spanned $151,922 to $231,123/QALY against benchmarks of $100,000 to $150,000, while European ratios ran from €128,343 to €273,895/QALY against benchmarks of €24,000 to €80,000. Ratios looked better after progression on an earlier tyrosine kinase inhibitor, reaching $159,126/QALY in the United States, and £41,705/QALY in the United Kingdom, once end-of-life criteria were applied.
Findings split most sharply over adjuvant treatment: models assuming a share of patients were cured favored osimertinib, whereas those treating the benefit as postponed relapse did not. Its U.S. acquisition cost of roughly $17,000 monthly dominated spending in all nine analyses.
“Osimertinib confers meaningful clinical benefit, but its value for money is context-specific and often uncertain at current list prices,” the study authors wrote. They urged caution given the small, dissimilar pool of models, and pointed to lower pricing, careful patient selection, longer survival follow-up, and reimbursement tied to outcomes as conditions for affordable use.
Disclosures: For full disclosures of the study authors, visit wiley.com.
