1. Cost-Effectiveness Analysis of Atezolizumab Versus Durvalumab as First-Line Treatment of Extensive-Stage Small-Cell Lung Cancer in the USA.
- Author
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Ionova, Yelena, Vuong, Wilson, Sandoval, Omar, Fong, Jodie, Vu, Vincent, Zhong, Lixian, and Wilson, Leslie
- Subjects
Humans ,Carcinoma ,Non-Small-Cell Lung ,Lung Neoplasms ,Antineoplastic Combined Chemotherapy Protocols ,Antibodies ,Monoclonal ,Quality-Adjusted Life Years ,Cost-Benefit Analysis ,United States ,Antibodies ,Monoclonal ,Humanized ,Cancer ,Comparative Effectiveness Research ,Clinical Trials and Supportive Activities ,Lung ,Cost Effectiveness Research ,Clinical Research ,Lung Cancer ,8.2 Health and welfare economics ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Health and social care services research ,Pharmacology and Pharmaceutical Sciences ,Pharmacology & Pharmacy - Abstract
Background and objectivesDurvalumab and atezolizumab are approved as first-line therapy in extensive-stage small-cell lung cancer. Although cost-effectiveness analyses compared these immunotherapy drugs with standard chemotherapy-alone regimens, no head-to-head cost-effectiveness comparisons for these treatments exist. The aim of the present analysis is to determine the cost-effectiveness of durvalumab and atezolizumab as first-line therapy for extensive-stage small-cell lung cancer from the US payers' perspective.MethodsThis study is based on two placebo-controlled, phase 3 clinical trials: CASPIAN and IMpower133. A Markov model was developed to simulate the three health states: progression-free survival, progressed disease, and death in patients with extensive-stage small-cell lung cancer. Transition probabilities were estimated from the clinical trial survival curves and extended with life-time modelling. Health utilities and direct costs of adverse event treatment were included. Main outcome was the incremental cost-effectiveness ratio (ICER) using quality-adjusted life-years saved (QALYS). Sensitivity analysis was performed to assess the impact of variables on the ICER.ResultsDurvalumab group has a cost of $187,503 with an effectiveness of 1.08 while atezolizumab has a cost of $160,219 and an effectiveness of 0.932. Durvalumab is not cost-effective compared to atezolizumab with an ICER of $165,182 QALYS, which is over the willingness-to-pay threshold of $150,000. The model was most sensitive to durvalumab cost and the cost of treating durvalumab adverse effects.ConclusionsWith the ICER of durvalumab treatment group being very close to $150,000, setting a higher willingness-to-pay threshold or decreasing the drug cost through contract pricing can increase the cost-effectiveness of durvalumab compared to atezolizumab.
- Published
- 2022