An updated cost-effectiveness analysis of osimertinib versus placebo in resected EGFR-mutated non-small cell lung cancer - the perspective of the United States

Sep 30, 2026

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Focuses on balancing osimertinib efficacy and cost for patients with completely resected stage IB–IIIA EGFR-mutated non-small cell lung cancer from the United States healthcare system perspective. Applies an exhaustive Markov model over a 30-year horizon to estimate incremental cost-effectiveness ratio, quality-adjusted life-years, and life-years at a $150,000/QALY willingness-to-pay threshold. Conducts sensitivity and subgroup analyses to test model stability. Concludes that prolonged adjuvant osimertinib is not cost-effective versus placebo overall, though it yields more favorable health outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

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Abstract

Background

Methods

Results

Conclusions

Introduction

Chen et al. BMC Health Services Research (2026) 26:38 BMC Health Services Research [https://doi.org/10.1186/s12913-025-13958-1](https://doi.org/10.1186/s12913-025-13958-1) RESEARCH Open Access An updated cost-effectiveness analysis of osimertinib versus placebo in resected EGFR-mutated non-small cell lung cancer: the perspective of the United States Fangping Chen1,2*, Xiaowei Xu1,2 and Xiaocong Wang1,2 Abstract Background The ADAURA trial reported a significant overall survival benefit of the use of adjuvant treatment with osimertinib following complete resection of stage IB‒IIIA non-small cell lung cancer (NSCLC) with epidermal gerowth factor receptor (EGFR) mutation. Herein, we aimed to strike an appropriate balance between osimertinib efficacy and cost in this patient population from the United States (US) healthcare system perspective. Methds We used an exhaustive Markov model over a 30-year time horizon to analyze primary health outcomes such as incremental cost-effectiveness ratio (ICER), quality-adjusted life-years (QALYs), and life-years (LYs) with osimertinibadjuvant treatment in contrast to placebo in a group of patients with completely resected EGFR-mutated NSCLC at a willingness-to-pay of $150,000/QALY. Sensitivity analyses were performed to determine the model’s stability, together with subgroup analyses on the cohort. Results In comparison with placebo, osimertinib was associated with an enhancement effectiveness (cost) of 6.32 ($1,250,406) QALYs, which led to an ICER of $197,994 per QALY for the overall patient population. ICERs were consistently higher than $150,000/QALY. In the sensitivity analysis, cost of osimertinib and utility of disease progression mildly influenced ICER. The osimertinib regimen was not cost-effective in all subgroup analyses. Conclusions In contrast to placebo, prolonged adjuvant osimertinib was not cost-effective in resected EGFRmutated NSCLC patients in the US. However, it can provide more favorable health benefits. Keywords EGFR-mutated non-small-cell lung cancer, Markov model, Cost-effectiveness analysis, Osimertinib, Adjuvant treatment *Correspondence: Fangping Chen [cabbagechen204@163.com](cabbagechen204@163.com) 1Department of Stomatology, Changsha Stomatological Hospital, Changsha, Hunan 410004, China 2Department of Stomatology, School of Stomatology, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/licenses/by-nc-nd/4.0/](vecommons.org/licenses/by-nc-nd/4.0/.)[.](vecommons.org/licenses/by-nc-nd/4.0/.) Chen et al. BMC Health Services Research (2026) 26:38 Introduction While the annual incidence of lung cancer has declined over the past decade, it is still the most common and lethal malignancy worldwide, accounting for 12.4% of new cancer cases and 18.7% of cancer deaths [1]. In America, lung cancer is the second most common malignancy; there are estimated 238,340 new cases and 127,070 mortality in 2023 a

FAQs

What clinical question does the analysis address?

It evaluates whether adjuvant osimertinib provides an acceptable trade-off between effectiveness and cost compared with placebo for completely resected EGFR-mutated non-small cell lung cancer in the US setting.

How were outcomes and cost-effectiveness estimated?

A 30-year Markov model estimated incremental cost-effectiveness ratio (ICER), quality-adjusted life-years (QALYs), and life-years (LYs) at a willingness-to-pay of $150,000 per QALY.

What were the main cost-effectiveness findings?

Compared with placebo, osimertinib produced higher effectiveness at increased costs, resulting in an overall ICER of $197,994 per QALY, which stayed above the $150,000/QALY threshold in consistently higher results. Sensitivity analyses showed mild influence from osimertinib cost and disease-progression utility, and the regimen was not cost-effective across all subgroups.

Sep 30, 2026

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