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- Title
International Cost-Effectiveness Analysis of Durvalumab in Stage III Non–Small Cell Lung Cancer.
- 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
- Abstract
Key Points: Question: Is maintenance durvalumab therapy cost-effective from the perspective of multiple payers for the treatment of unresectable stage III non–small cell lung cancer? Findings: In this economic evaluation Markov model simulation, durvalumab was not cost-effective from the perspective of the US, Brazil, Singapore, or Spain at current pricing compared with established health economics thresholds. Discounted acquisition costs in Singapore facilitated cost-effectiveness. Meaning: The findings of this study suggest that value-based pricing is an alternative model that industry might adapt to inform global pricing strategies that minimize financial toxicity and increase global access to oncology drugs. Importance: 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. Objective: 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). Design, Setting, and Participants: 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. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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. The findings of the study suggest that discounted durvalumab acquisition costs, as possible in Singapore, might improve cost-effectiveness globally. This economic evaluation compares the cost-effectiveness of durvalumab for maintenance treatment of stage III non–small cell lung cancer (NSCLC) across the US, Brazil, Singapore, and Spain.
- Subjects
SINGAPORE; UNITED States; SPAIN; BRAZIL; THERAPEUTIC use of antineoplastic agents; THERAPEUTIC use of monoclonal antibodies; CLINICAL medicine; QUALITY-adjusted life years; COST effectiveness; DRUG side effects; ANTINEOPLASTIC agents; IMMUNOTHERAPY; TREATMENT effectiveness; EVALUATION of medical care; DESCRIPTIVE statistics; MONOCLONAL antibodies; QUALITY of life; LUNG cancer; TUMOR classification; CONFIDENCE intervals; SENSITIVITY &; specificity (Statistics); MEDICAL care costs; DISEASE progression
- Publication
JAMA Network Open, 2024, Vol 7, Issue 5, pe2413938
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.13938