Healthcare costs following osimertinib versus earlier-generation tyrosine kinase inhibitor initiation in non–small cell lung cancer: A U.S. claims-based study.

Abstract

e20762 Background: EGFR-targeted tyrosine kinase inhibitors (EGFR-TKIs) are the standard first-line treatment for patients with EGFR-positive non-small cell lung cancer (NSCLC). Osimertinib, a third-generation EGFR-TKI, exhibited superior clinical outcomes compared to 1 st or 2 nd -generation (1/2G) TKIs; real-world data on healthcare costs after treatment initiation remain limited. The aim of this study is to compare healthcare costs following initiation of Osimertinib versus earlier-generation therapies using administrative claims data. Methods: A retrospective cohort study was conducted using the Merative MarketScan Commercial Claims and Medicare Supplemental databases (2016–2024). Chemotherapy-naïve adults with NSCLC who newly initiated Osimertinib or 1/2G-EGFR-TKIs were identified and followed for 6 months from the first date of the TKI dispensing encounter (Index Date). NSCLC status was confirmed using ICD-10 diagnosis codes within ±14 days of the Index Date. We calculated per-patient means and medians of the aggregated 6-month all-cause costs across inpatient, outpatient, and outpatient pharmacy settings. Costs were adjusted to 2025 US dollars. Results: The study included 1,355 patients from the Commercial Claims database, including 1,132 Osimertinib and 223 1/2G-TKI patients. From the Medicare Supplemental database, a total of 1,082 individuals were identified, consisting of 569 Osimertinib 513 1/2G-TKI patients. The mean age was 53 years in the Commercial cohort and 75 years in the Medicare cohort, with approximately 70% female in both populations. Mean (median) all-cause healthcare costs for Osimertinib vs. 1/2G-TKI from the Commercial claims cohort were $169,937 ($147,536) vs. $102,221 ($89,156), respectively, consisting of the inpatient costs of $12,710 vs. $13,415, outpatient care costs of $35,620 vs. $23,789, and pharmacy costs of $121,607 vs. $65,017. From the Medicare Cohort, the total respective costs of $139,303 ($134,147) vs. $99,575 ($83,954) comprised $10,265 vs. $8,631 inpatient medical costs, $21,917 vs $29,952 outpatient medical costs, and $107,122 vs. $60,992 pharmacy costs. Conclusions: Treatment with Osimertinib was associated with higher total healthcare costs compared with 1/2G-TKIs, with consistent findings across both Commercial and Medicare cohorts. The cost escalation driven by higher outpatient pharmacy costs might not be fully offset by cost savings from the medical sectors, which should be further explored by additional research considering changes in treatment patterns and adjustments for patient characteristics.