Cost-Effectiveness of First-Line Chemo-Immunotherapy for Extensive-Stage SCLC

Study findings suggest atezolizumab plus etoposide and platinum chemotherapy is superior to durvalumab plus etoposide and platinum chemotherapy for treating extensive-stage small cell lung cancer (SCLC), though neither strategy was cost-effective compared to etoposide plus platinum chemotherapy alone (Front Oncol. 2021;11:699781. doi:10.3389/fonc.2021.699781).

Atezolizumab combined with etoposide and platinum, and durvalumab combined with etoposide and platinum were recently approved in the United States as first-line chemotherapy immunotherapies for patients with extensive-stage SCLC, however, their cost-effectiveness was unknown.

Qiao Liu, MD, Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China, and colleagues aimed to assess the cost-effectiveness of atezolizumab combined with etoposide and platinum, and durvalumab combined with etoposide and platinum for patients with extensive-stage SCLC.

Authors compared the cost-effectiveness of atezolizumab combined with etoposide and platinum, durvalumab combined with etoposide and platinum, and etoposide plus platinum over a 10-year time horizon, using a Markov model.  Authors gathered data on clinical efficacy and safety from the IMpower 133 and CASPIAN trials, and health state utilities from published literature.

When compared with durvalumab combined with etoposide and platinum, adult patients with treatment-naïve extensive-stage SCLC who received atezolizumab combined with etoposide and platinum experienced improved quality adjusted life years (QALYs) by 0.16 and $5,737 in reduced costs. 

When compared with etoposide plus platinum chemotherapy, atezolizumab combined with etoposide and platinum increased QALYs by 0.162, while durvalumab combined with etoposide and platinum increased QALYs by 0.146. However, health costs of both chemo-immunotherapies were substantially higher than etoposide plus platinum chemotherapy, with ICERs of $382,469 per QALY for atezolizumab combined with etoposide and platinum, and $464,593 per QALY for durvalumab combined with etoposide and platinum.

First-line atezolizumab combined with etoposide and platinum was a dominant treatment strategy over durvalumab combined with etoposide and platinum, however, neither were considered cost-effective when compared with etoposide plus platinum chemotherapy.

Atezolizumab combined with etoposide and platinum provided a balance between incremental cost and QALY when compared to durvalumab combined with etoposide and platinum.

“When new combination therapies with remarkable effect become pivotal in the first-line treatment, the price reduction of these drugs may be essential to achieving cost-effectiveness,” concluded Dr Liu and colleagues.—Marta Rybczynski