Dr Lopes on a Cost Analysis of Osimertinib/Chemo vs Amivantamab/Lazertinib in EGFR+ NSCLC

“With the intensive management of adverse [effects] required for treatment with amivantamab and lazertinib, and considering that both treatments are newer agents and not yet off patent, it is not surprising to see that amivantamab plus lazertinib was more expensive than using mostly generic chemotherapy, [such as] carboplatin and pemetrexed, with an oral TKI, osimertinib, that, while still expensive, is very likely to come off patent in just a few years.”

Gilberto Lopes, MD, MBA, FAMS, chief of the Division of Medical Oncology and associate director for global oncology at Sylvester Comprehensive Cancer Center, discussed findings from a cost-effectiveness analysis evaluating osimertinib (Tagrisso) plus chemotherapy vs amivantamab-vmjw (Rybrevant) plus lazertinib (Lazcluze) for the treatment of patients with previously untreated, EGFR-mutated locally advanced or metastatic non–small cell lung cancer (NSCLC).

The study utilized a cost-of-care model developed from the perspective of United Stated payers and assessed costs associated with drug acquisition, adverse effect (AE) management, and health care resource utilization over the first year of treatment with both regimens. The largest cost drivers were identified as drug pricing and the management of treatment-emergent toxicities, particularly for regimens requiring infusion-related monitoring and supportive care, Lopes explained.

Findings from the analysis showed that osimertinib plus chemotherapy was associated with substantially lower overall costs compared with amivantamab plus lazertinib, Lopes said. The cost difference was driven by the use of lower-cost, largely generic chemotherapy agents such as carboplatin and pemetrexed. In contrast, both amivantamab and lazertinib remain branded agents with higher acquisition costs and increased AE-related health care utilization.

Although cost is not typically the primary consideration in treatment selection for physicians, Lopes noted that financial toxicity remains a concern for many patients in the United States, particularly those with high co-pays or limited insurance coverage. He emphasized that although clinical efficacy such as overall survival (OS) and progression-free survival (PFS) remains paramount when selecting a therapy, economic factors and treatment tolerability should also be incorporated into shared decision-making discussions.