ArticleClinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico2026
First-line versus second-line use of selpercatinib in treatment of RET fusion-positive advanced non-small cell lung cancer: a cost-effectiveness analysis.
Article in Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThis study aimed to evaluate the cost-effectiveness of using selpercatinib as a first-line treatment option or reserving it for second-line use versus relying exclusively on chemotherapy in managing RET fusion-positive advanced non-small cell lung cancer (NSCLC), to identify the optimal treatment strategy from the perspective of US payers. MATERIALS AND
methodsA partitioned survival model (PSM) was constructed to assess the clinical outcomes and healthcare costs of two selpercatinib-containing strategies-first-line selpercatinib and second-line selpercatinib-each compared with chemotherapy alone for patients with advanced NSCLC harboring RET fusions. The costs and utility values were determined using the existing literature and standard fee databases as per prior research. To assess model robustness, both probabilistic sensitivity analysis and univariate sensitivity analysis were performed.
resultsCompared with chemotherapy alone, first-line selpercatinib was associated with an incremental gain of 0.12 quality-adjusted life-years (QALYs) at an additional cost of $117,682, resulting in an incremental cost-effectiveness ratio (ICER) of $953,637.15 per QALY. Second-line selpercatinib was associated with an incremental gain of 0.13 QALYs at an additional cost of $68,569, resulting in an ICER of $526,970.29 per QALY. The variables with the most significant impact on the ICER were the cost of selpercatinib and utility values. To be cost-effective at a willingness-to-pay (WTP) threshold of $150,000 per QALY, the price of selpercatinib would need to be reduced by 69.94% in the first-line setting, or by 77.08% in the second-line setting.
conclusionGiven the current pricing, neither selpercatinib as a first-line therapy nor as a second-line therapy was deemed to be cost-effective compared with chemotherapy for advanced NSCLC patients with RET fusions. Further real-world studies of selpercatinib and development of health outcome estimate scales are needed to provide additional evidence for clinicians and health policy decision-makers.
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