Cost Advantage of Sotorasib in KRAS G12C–Mutated NSCLC

By: Julia Cipriano, MS, CMPP
Posted: Tuesday, February 17, 2026

In a comparison of current efficacy and safety data for KRAS G12C inhibitors, sotorasib demonstrated greater cost-effectiveness than adagrasib for second- and subsequent-line treatment of KRAS G12C–mutated non–small cell lung cancer (NSCLC) from a U.S. private payer perspective, according to David Waterhouse, MD, MPH, of Oncology Hematology Care, Cincinnati, and colleagues. Their findings were published in the Journal of Medical Economics.

“Sotorasib and adagrasib have comparable efficacy based on currently available data, whereas sotorasib has a more favorable safety profile, which translates into a modest QALY [quality-adjusted life-years] gain, and a lower acquisition cost,” the investigators commented.

The analysis used a standard three-state partitioned survival model with a 20-year lifetime horizon. The base case assumed equal progression-free and overall survival based on published matching-adjusted indirect comparisons from phase 2 and 3 trials, with time-to-death utilities applied. Treatment-related adverse events common to both treatments were included, and direct costs and health benefits were discounted at 1.5% annually. Model robustness was assessed using probabilistic sensitivity analysis and inputs varied in scenario analyses.  

Base-case results showed sotorasib to be more cost-effective than adagrasib, driven by lower acquisition costs and fewer treatment-related adverse events. Total discounted costs were $18,004 higher with adagrasib than with sotorasib ($246,557 vs $228,553), reflecting greater drug acquisition costs ($9,478 more), more costly treatment-related adverse event management ($4,103 more), and increased use of concomitant medications such as antiemetics and antidiarrheal agents ($4,424 more). Sotorasib was found to be dominant at equivalent efficacy (1.20 QALYs). At a willingness-to-pay threshold of $150,000 per QALY, the net monetary benefit amounted to $18,031.

In the probabilistic sensitivity analysis, sotorasib was more likely to be cost-effective than adagrasib at every willingness-to-pay threshold, with a 62% probability at $150,000 per QALY. Scenario analyses of relative efficacy, discount rate, time horizon, and utilities consistently favored sotorasib for cost-effectiveness, according to the investigators, with incremental cost-effectiveness ratios “well below” the $150,000 per QALY willingness-to-pay threshold.

Disclosure: For full disclosures of the study authors, visit tandfonline.com.

Journal of Medical Economics

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