Durvalumab Immunotherapy Shows Survival Benefit but Fails Cost-Effectiveness in Key Markets

Durvalumab immunotherapy improves survival in unresectable stage III non-small cell lung cancer (NSCLC), but its high cost makes it prohibitive in the US, Brazil, Singapore, and Spain under current pricing models, according to study results published in JAMA Network Open.

Researchers conducted the study from June 2022 to December 2023 and evaluated the cost-effectiveness of durvalumab maintenance therapy following chemoradiotherapy for unresectable stage III NSCLC. They used a Markov decision-analytic model based on data from the PACIFIC trial and other relevant studies to simulate patient outcomes over a 10-year horizon.

“Given multiple limitations to the global use of maintenance durvalumab in this setting, we conducted a cost-effectiveness analysis according to 4 country perspectives: (1) the US, (2) Brazil, (3) Singapore, and (4) Spain,” explained Samuel Kareff, MD, MPH, University of Miami Sylvester Comprehensive Cancer Center/Jackson Memorial Hospital in Miami, Florida, and coauthors.

While durvalumab improved median overall survival (OS) and progression-free survival (PFS) compared with placebo, the incremental cost-effectiveness ratios (ICERs) exceeded established willingness-to-pay thresholds in all 4 countries. In the US, the ICER per quality-adjusted life-year (QALY) was $228 788, significantly higher than the $150 000 per QALY threshold.

Similar results were observed in Brazil ($141 146 per QALY), Singapore ($153 461 per QALY), and Spain ($125 193 per QALY), all surpassing their respective country-specific thresholds. The study also conducted sensitivity analyses, which showed that the utility of progression-free survival with durvalumab had the strongest impact on incremental QALYs across all countries.

“In this economic evaluation, durvalumab was not cost-effective in our model in any of the 4 countries studied despite being highly efficacious in the maintenance setting after consolidative chemoradiotherapy for unresectable stage III NSCLC,” concluded the study authors.

Reference

Kareff SA, Han S, Haaland B, et al. International cost-effectiveness analysis of durvalumab in stage III non-small cell lung cancer. JAMA Netw Open. 2024;7(5):e2413938. doi:10.1001/jamanetworkopen.2024.13938