Advertisement

Cost-Effectiveness of Tepotinib versus Capmatinib for the Treatment of Adult Patients with Metastatic Non-Small Cell Lung Cancer Harboring Mesenchymal–epithelial Transition Exon 14 (METex14) Skipping

Open AccessPublished:December 07, 2022DOI:https://doi.org/10.1016/j.jval.2022.11.018
      This paper is only available as a PDF. To read, Please Download here.

      HIGHLIGHTS

      • The recently approved and recommended tyrosine kinase inhibitor (TKI) treatments tepotinib and capmatinib offer efficacious and tolerable treatment options for adults with metastatic non-small cell lung cancer (NSCLC) harboring mesenchymal–epithelial transition factor gene exon 14 (METex14) skipping in the US.
      • This study assessed the cost-effectiveness of tepotinib versus capmatinib for this patient population in frontline, subsequent line, and any setting (overall), from a US Medicare payer perspective.
      • Tepotinib could be cost-effective versus capmatinib in treating adults with metastatic NSCLC harboring METex14 skipping in frontline settings and overall, whereas cost-effectiveness in subsequent lines depends on willingness-to-pay for additional quality-adjusted life-years.

      ABSTRACT

      Objectives

      From the US Medicare perspective, this study compared the cost-effectiveness of tepotinib and capmatinib for treating metastatic NSCLC with tumors harboring mesenchymal–epithelial transition factor gene exon 14 (METex14) skipping.

      Methods

      A three-state partitioned survival model assessed outcomes over a lifetime horizon. Parametric survival analysis of the Phase 2 VISION trial informed clinical inputs for tepotinib. Capmatinib inputs were captured using hazard ratios derived from an unanchored matching-adjusted indirect comparison study and published literature. National cost databases, trial data, and literature furnished drug, treatment monitoring, and disease/adverse event management expenditures (2021 US dollars) and utility inputs. Outcomes were discounted at 3% annually.

      Results

      In the base-case, tepotinib dominated capmatinib in frontline settings (incremental discounted quality-adjusted life-years [QALYs] and costs of 0.2127 and -$47,756, respectively) while realizing an incremental cost-effectiveness ratio (ICER) of $274,514/QALY in subsequent lines (incremental QALYs and costs of 0.3330 and $91,401, respectively). In a line agnostic context, tepotinib produced an ICER of $105,383/QALY (incremental QALYs and costs of 0.2794 and $29,447, respectively). Sensitivity and scenarios analyses for individual lines typically supported the base-case, while those for the line agnostic setting suggested sensitivity to drug acquisition costs and efficacy inputs.

      Conclusion

      Tepotinib could be cost-effective versus capmatinib in frontline and line agnostic contexts, considering the range of willingness-to-pay (WTP) thresholds recommended by the Institute for Clinical and Economic Review ($100,000–150,000/QALY). Tepotinib could be cost-effective in subsequent lines at higher WTP levels. These results are to be interpreted cautiously, considering uncertainty in key model inputs.

      Keywords