Durvalumab Added to Etoposide Plus Platinum is Not Cost-Effective for First-Line Treatment of Extensive-Stage SCLC

Adding durvalumab to etoposide and platinum is not cost-effective compared with etoposide and platinum alone for patients with newly diagnosed extensive-stage small cell lung cancer (SCLC) from a US payer perspective (Oncologist. 2021;26[11]:e2013-e2020. doi:10.1002/onco.13954).

"The latest published CASPIAN trial demonstrated that adding durvalumab to etoposide and platinum improved survival dramatically for patients with extensive-stage [SCLC],” wrote Shen Lin, Department of Pharmacy, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China, and colleagues.

This study examined the cost-effectiveness of adding durvalumab to etoposide and platinum in the first-line treatment setting for patients with extensive-stage SCLC from the US payer perspective.

A 3-state Markov model was developed to simulate the disease course and source consumption of extensive-stage SCLC over a lifetime horizon. Digitized Kaplan-Meier Curves were used to generate individual patient-level data. The Centers for Medicare and Medicaid Services, Healthcare Cost and Utilization Project, and relevant literature were used to obtain direct medical costs, including drug and administration costs, disease management and adverse events treatment fees, best supportive care and terminal care costs.

The main study outcomes were total costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). All costs were adjusted for inflation to reflect 2019 US dollars. The willingness-to-pay (WTP) threshold was $150,000 per QALY.

Durvalumab plus etoposide and platinum was estimated to increase LYs by 0.86 and QALYs by 0.44 compared with etoposide and platinum alone. The incremental treatment cost was $95,907 with a corresponding ICER of $216,953 per QALY.

At a WTP threshold of $150,000 per QALY, the estimated probability of durvalumab plus etoposide and platinum to be cost-effective was 9.4%. To be considered cost-effective in comparison with etoposide and platinum alone, the price of durvalumab would have to be reduced by 30.7%.

“From the perspective of the US payer, adding durvalumab to… [etoposide plus platinum] is estimated to be not cost-effective compared with EP alone for patients with untreated… [extensive-stage] SCLC,” concluded Lin and colleagues.