Abstract：
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.
OBJECTIVE: 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.
METHODS: 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.
CONCLUSIONS: 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.
OBJECTIVE: 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.
METHODS: 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.
CONCLUSIONS: 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.
摘要：
背景：尽管对表皮生长因子受体（EGFR）外显子20插入的非小细胞肺癌（NSCLC）患者，其成本效益需要进一步调查。
目的：从美国付款人的角度，评估阿米坦单抗联合化疗治疗EGFR外显子20插入的非小细胞肺癌患者的成本-效果。
方法：根据PAPILLON试验的数据建立分区生存模型。费用来自医疗保险和医疗补助服务的定价文件和出版的文献，和效用值来自以前的研究。每年3%的贴现率适用于成本和结果。主要结果是增量成本效益比（ICER）。单向敏感性分析，概率敏感性分析和情景分析，进行了模型稳定性测试。
结果：Amivantamab联合化疗产生了额外的1.12个质量调整生命年（QALYs），同时相对于化疗方案增加了483,769.50美元的成本，导致ICER为432,401.16美元/季度。在$150,000/QALY的阈值下，amivantamab与化疗的组合并不具有成本效益。在情景分析中，结果表明，当采用不同的效用值和10年时间跨度时，ICER为263,680.69美元/QALY和418,416.35美元/QALY，分别。对于PSA,如果支付意愿(WTP)阈值为$150,000/QALY,则amivantamab+化疗具有成本效益的概率为0%.
结论：对于EGFR外显子20插入的NSCLC患者，Amivantamab联合化疗不太可能是一种具有成本效益的选择。降低amivantamab的成本可能会产生有利的经济结果。
目的：从美国付款人的角度，评估阿米坦单抗联合化疗治疗EGFR外显子20插入的非小细胞肺癌患者的成本-效果。
方法：根据PAPILLON试验的数据建立分区生存模型。费用来自医疗保险和医疗补助服务的定价文件和出版的文献，和效用值来自以前的研究。每年3%的贴现率适用于成本和结果。主要结果是增量成本效益比（ICER）。单向敏感性分析，概率敏感性分析和情景分析，进行了模型稳定性测试。
结果：Amivantamab联合化疗产生了额外的1.12个质量调整生命年（QALYs），同时相对于化疗方案增加了483,769.50美元的成本，导致ICER为432,401.16美元/季度。在$150,000/QALY的阈值下，amivantamab与化疗的组合并不具有成本效益。在情景分析中，结果表明，当采用不同的效用值和10年时间跨度时，ICER为263,680.69美元/QALY和418,416.35美元/QALY，分别。对于PSA,如果支付意愿(WTP)阈值为$150,000/QALY,则amivantamab+化疗具有成本效益的概率为0%.
结论：对于EGFR外显子20插入的NSCLC患者，Amivantamab联合化疗不太可能是一种具有成本效益的选择。降低amivantamab的成本可能会产生有利的经济结果。
