Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA, USA.
School of Pharmacy, University of California San Francisco, San Francisco, CA, USA.
Clin Drug Investig. 2022 Jun;42(6):491-500. doi: 10.1007/s40261-022-01157-3. Epub 2022 May 23.
Durvalumab 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.
This 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.
Durvalumab 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.
With 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.
度伐利尤单抗和阿替利珠单抗被批准作为广泛期小细胞肺癌的一线治疗药物。尽管成本效益分析比较了这些免疫治疗药物与标准的单独化疗方案，但这些治疗方法之间没有直接的成本效益比较。本分析旨在从美国支付者的角度确定度伐利尤单抗和阿替利珠单抗作为广泛期小细胞肺癌一线治疗的成本效益。
本研究基于两项安慰剂对照的 III 期临床试验：CASPIAN 和 IMpower133。建立了一个马尔可夫模型来模拟广泛期小细胞肺癌患者的无进展生存期、进展性疾病和死亡三种健康状态。转移概率是从临床试验的生存曲线中估计出来的，并通过终生建模进行了扩展。包括健康效用和不良反应治疗的直接成本。主要结果是使用节省的质量调整生命年（QALYS）的增量成本效益比（ICER）。进行了敏感性分析以评估变量对 ICER 的影响。
度伐利尤单抗组的成本为 187503 美元，有效性为 1.08，而阿替利珠单抗组的成本为 160219 美元，有效性为 0.932。与阿替利珠单抗相比，度伐利尤单抗的 ICER 为 165182 美元/QALY，超过了 150000 美元的意愿支付阈值，因此度伐利尤单抗不具有成本效益。模型对度伐利尤单抗的成本和度伐利尤单抗不良反应治疗的成本最为敏感。
由于度伐利尤单抗治疗组的 ICER 非常接近 150000 美元，通过设定更高的意愿支付阈值或通过合同定价降低药物成本，可以提高度伐利尤单抗相对于阿替利珠单抗的成本效益。
