International Cost-Effectiveness Analysis of Durvalumab in Stage III Non-Small Cell Lung Cancer

Standard of care for unresectable locally advanced non-small cell lung cancer (NSCLC) involves definitive chemoradiotherapy followed by maintenance therapy with durvalumab. However, the cost of durvalumab has been cited as a barrier to its use in various health systems. To evaluate the cost-effectiv...

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Published in:JAMA network open 2024-05, Vol.7 (5), p.e2413938
Main Authors: Kareff, Samuel A, Han, Sunwoo, Haaland, Benjamin, Jani, Chinmay J, Kohli, Rhea, Aguiar, Jr, Pedro Nazareth, Huang, Yiqing, Soo, Ross A, Rodríguez-Perez, Ángel, García-Foncillas, Jesús, Dómine, Manuel, de Lima Lopes, Gilberto
Format: Article
Language:English
Subjects:
Aged
Antibodies, Monoclonal - economics
Antibodies, Monoclonal - therapeutic use
Antineoplastic Agents, Immunological - economics
Antineoplastic Agents, Immunological - therapeutic use
Brazil
Carcinoma, Non-Small-Cell Lung - drug therapy
Carcinoma, Non-Small-Cell Lung - economics
Cost-Benefit Analysis
Cost-Effectiveness Analysis
Female
Humans
Lung Neoplasms - drug therapy
Lung Neoplasms - economics
Male
Markov Chains
Middle Aged
Neoplasm Staging
Quality-Adjusted Life Years
Singapore
Spain
United States
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Summary:Standard of care for unresectable locally advanced non-small cell lung cancer (NSCLC) involves definitive chemoradiotherapy followed by maintenance therapy with durvalumab. However, the cost of durvalumab has been cited as a barrier to its use in various health systems. To evaluate the cost-effectiveness of durvalumab vs placebo as maintenance therapy in patients with unresectable stage III NSCLC from 4 international payer perspectives (US, Brazil, Singapore, and Spain). In this economic evaluation, a Markov model was designed to compare the lifetime cost-effectiveness of maintenance durvalumab for unresectable stage III NSCLC with that of placebo, using 5-year outcomes data from the PACIFIC randomized placebo-controlled trial. Individual patient data were extracted from the PACIFIC, KEYNOTE-189, ADAURA, ALEX, and REVEL randomized clinical trials to develop a decision-analytic model to determine the cost-effectiveness of durvalumab compared with placebo maintenance therapy over a 10-year time horizon. Direct costs, adverse events, and patient characteristics were based on country-specific payer perspectives and demographic characteristics. The study was conducted from June 1, 2022, through December 27, 2023. Life-years, quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs) were estimated at country-specific willingness-to-pay thresholds ([data reported in US$] US: $150 000 per QALY; Brazil: $22 251 per QALY; Singapore: $55 288 per QALY, and Spain: $107 069 per QALY). One-way and probabilistic sensitivity analyses were performed to account for parameters of uncertainty. A cost-threshold analysis was also performed. The US base-case model found that treatment with durvalumab was associated with an increased cost of $114 394 and improved effectiveness of 0.50 QALYs compared with placebo, leading to an ICER of $228 788 per QALY. Incremental cost-effectiveness ratios, according to base-case models, were $141 146 for Brazil, $153 461 for Singapore, and $125 193 for Spain. Durvalumab price adjustments to the PACIFIC data improved cost-effectiveness in Singapore, with an ICER of $45 164. The model was most sensitive to the utility of durvalumab. In this cost-effectiveness analysis of durvalumab as maintenance therapy for unresectable stage III NSCLC, the therapy was found to be cost-prohibitive from the perspective of various international payers according to country-specific willingness-to-pay thresholds per QALY.
ISSN:2574-3805
2574-3805
DOI:10.1001/jamanetworkopen.2024.13938