Sotorasib Versus Docetaxel in Advanced Non-Small Cell Lung Cancer With Kras G12C Mutation: Cost-Effectiveness and Value of Information Analyses

Abstract

Background: Sotorasib is a first-in-class oral KRAS G12C inhibitor and has shown improved safety and efficacy compared to docetaxel in patients with advanced non-small cell lung cancer (NSCLC) who have KRAS G12C mutation and have previously been treated.Objective: To estimate the cost-effectiveness of sotorasib compared to docetaxel in KRAS G12C mutated advanced NSCLC and to determine the cost of uncertainty and whether future research will be beneficial by estimating the expected value of perfect information (EVPI). Methods: A 3-state partitioned survival model (progression-free, progressed, death) over a time horizon of 5 years and from a payer perspective in the United States was developed. Estimates of the progression-free and overall survival were determined from the Kaplan-Meier curves of the CodeBreak 200 trial based on the best-fitting parametric distribution. Costs of drugs and subsequent systemic treatments were sourced from Redbook, administration costs from Physician Fee Schedule, cost of adverse events management, and utilities from published literature. Model outcomes included incremental cost, quality-adjusted life-year (QALY), and incremental cost-utility ratio (ICUR). One-way and probabilistic sensitivity analyses (PSA) were used to account for the uncertainties in the model. Discounting at 3% per year was utilized. Using results from the PSA, the net health benefits (NHBs) and net monetary benefits (NMBs) forgone and population EVPI were calculated. Results: Sotorasib yielded an increase of 0.35 QALYs at an incremental cost of $329,619. At a willingness to pay threshold (WTP) of $150,000 per QALY, the incremental cost per QALY gained (ICUR) was $941,768. The acceptability curve indicated that the likelihood of attaining cost-effectiveness at $150,000 WTP was 3% vs. 97% for sotorasib and docetaxel respectively. The average per-patient NHBs and NMBs forgone were 0.061QALYs and $5019 respectively, while the population EVPI was estimated to be $627.3 million. Conclusion: Sotorasib may require a higher WTP threshold or a reduction in acquisition cost for it to be considered cost-effective. Additionally, uncertainty in its clinical efficacy compared to docetaxel persists, and future research to acquire additional evidence may be beneficial.