A cost-effectiveness analysis of consolidation immunotherapy with durvalumab in stage III NSCLC responding to definitive radiochemotherapy in Switzerland

Panje, Cédric; Lupatsch, Judith; Barbier, Michaela; Pardo, E.; Lorez, Matthias; Dedes, KJ; Aebersold, Daniel M.; Plaßwilm, Ludwig; Gautschi, Oliver; Schwenkglenks, Matthias

doi:10.1016/j.annonc.2020.01.007

Cited by 20 publications

(33 citation statements)

References 10 publications

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“…Numerous cost-effectiveness analyses have been published based on both the ITT and the PD-L1 TC ≥ 1% PACIFIC populations. These analyses report a lower range of QALY gains with durvalumab therapy (0.24-1.32 for the PD-L1 TC ≥ 1% population) compared with the original company base-case analysis (2.93) (Table 3 in the ESM) [30,31,[44][45][46][47][48]; this could be explained, in part, by the use of different modelling approaches, decision problems, and/or assumptions regarding long-term survival benefit. The recently published data from PACIFIC (March 2020 DCO) demonstrated a gain in median OS of 27.8 months with durvalumab therapy versus placebo and a sustained OS and PFS benefit with durvalumab at 4 years (PD-L1 TC ≥ 1% population) [34]; the 48-month OS rates were 55 and 38% with durvalumab and placebo, respectively.…”

Section: Discussionmentioning

confidence: 99%

Cost Effectiveness of Durvalumab in Unresectable Stage III NSCLC: 4-Year Survival Update and Model Validation from a UK Healthcare Perspective

Dunlop

Keep²,

Elroy³

et al. 2021

PharmacoEconomics Open

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Background In the phase III PACIFIC study, durvalumab improved survival versus placebo in patients with unresectable stage III non-small-cell lung cancer (NSCLC) whose disease had not progressed after platinum-based concurrent chemoradiotherapy. The appraisal by the UK's National Institute for Health and Care Excellence (NICE) included a cost-effectiveness analysis based on an early data readout from PACIFIC [March 2018 data cut-off (DCO); median follow-up duration 25.2 months; range 0.2-43.1]. Uncertainties regarding long-term survival outcomes with durvalumab led to some challenges in estimating the cost effectiveness of this therapy. Objective Here, we validate the survival extrapolations used in the original company base-case analysis by benchmarking them against updated survival data from the 4-year follow-up analysis of PACIFIC (i.e. approximately 4 years after the last patient was randomised; March 2020 DCO; median follow-up duration 34.2 months; range 0.2-64.9). Moreover, we update the original analysis with these more mature survival data to examine the consistency of key economic outputs with the original analysis. Methods The original analysis used a semi-Markov (state-transition) approach and was based on patients whose tumours expressed programmed cell death-ligand 1 on ≥ 1% of cells (to reflect the European licence for durvalumab). We benchmarked the survival extrapolations used in the original company base-case analysis against survival data from the 4-year follow-up of PACIFIC and updated the cost-effectiveness analysis with these more mature survival data. Early deaths avoided by the adoption of durvalumab into the UK Cancer Drugs Fund (CDF) in March 2019 were estimated using the 4-year follow-up survival data and an assumed uptake of 125 patients/year (lower estimate) and 367 patients/year (higher estimate). Results The original company base-case analysis had a good visual fit with the observed overall survival (OS) distribution for the durvalumab arm and accurately predicted the 48-month OS rate (predicted 55%; observed 55%); by comparison, the fit was less precise for the placebo arm, for which the analysis underestimated the 48-month OS rate (predicted 32%; observed 38%). In the updated company base-case analysis, durvalumab yielded 2.51 incremental quality-adjusted life-years (QALYs) (− 0.43 vs. the original company base-case analysis), corresponding to an incremental cost-effectiveness ratio of £22,665/QALY (+£3298 vs. the original analysis), which falls within the upper bound of NICE's willingness-to-pay threshold (£30,000/QALY gained). We estimate that between 31 and 91 early patient deaths may have been avoided by the adoption of durvalumab into the CDF. Conclusions These findings reinforce the patient benefit observed with durvalumab in unresectable stage III NSCLC, support the routine use and cost effectiveness of this therapy, and demonstrate how appropriate modelling can inform the early adoption of therapies by payers to achieve patient benefit. Plain Language SummaryBased on the re...

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Section: Discussionmentioning

confidence: 99%

Cost Effectiveness of Durvalumab in Unresectable Stage III NSCLC: 4-Year Survival Update and Model Validation from a UK Healthcare Perspective

Dunlop

Keep²,

Elroy³

et al. 2021

PharmacoEconomics Open

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“…Taking advantage of the molecular and cellular differences between tumor cells and normal cells, molecular targeted therapy targeting cell receptors, genes, and regulatory molecules as drug targets has gradually become a new strategy for the current clinical treatment of lung cancer, such as angiogenesis inhibitors and epidermal growth factor receptor inhibitors which have all been used in clinical applications. In addition, biological treatments including tumor vaccine technology, cytokine technology, monoclonal antibody technology, and gene therapy technology have gradually developed and transformed into clinical applications [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Identification of Gene Markers for Survival Prediction of Lung Adenocarcinoma Patients Based on Integrated Multibody Data Analysis

Bao

Luo

et al. 2021

Journal of Nanomaterials

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We constructed a prognostic-related risk prediction for patients with lung adenocarcinoma by integrating multiple omics information of lung adenocarcinoma clinical information group and genome and transcriptome. Blood samples and cancer and paracancerous lung tissue samples were collected from 480 patients with lung adenocarcinoma. DNA and RNA sequencing was performed on DNA samples and RNA samples. The first follow-up was carried out 3 months after discharge. Clinical information of patients including age, gender, smoking history, and TNM stage was collected. The Cox proportional hazard model evaluated more than 600 potential SNPs related to the prognosis of lung adenocarcinoma. After LASSO analysis, we obtained 4 SNPs related to the prognosis of lung adenocarcinoma (including rs1059292, rs995343, rs2013335, and rs8078328). Through the Cox proportional hazard model, 260 candidate genes related to the prognosis of lung adenocarcinoma were evaluated. After subsequent analysis, 3 genes related to the prognosis of lung adenocarcinoma (LDHA, SDHC, and TYMS) were obtained. All survived patients were spilt into a high-risk group ( n = 170 ) and a low-risk group ( n = 170 ) according to 4 SNPs and 3 genes related to the prognosis of lung adenocarcinoma. The overall survival rate of patients in the high-risk group was lower than that in the low-risk group. The prognostic risk prediction index constructed by combining clinical information group and genomic and transcriptome characteristics of multiomics information can effectively distinguish the prognosis of patients with lung adenocarcinoma, which will provide effective support for the precise treatment of patients with lung adenocarcinoma.

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“…outlined in Glick et al [26]}. The resulting ICERs were compared with a willingness-to-pay (WTP) threshold of Swiss Francs (CHF) 100,000/QALY, which is sometimes tentatively considered in analyses for Switzerland [27][28][29].…”

Section: Main Outcomesmentioning

confidence: 99%

Cost-effectiveness and budget impact of venetoclax in combination with rituximab in relapsed/refractory chronic lymphocytic leukemia in Switzerland

Barbier

Durno²,

Bennison³

et al. 2021

Eur J Health Econ

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Introduction Venetoclax in combination with rituximab (VEN + R) demonstrated prolonged overall survival (OS) and progression-free survival (PFS) for patients with relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL) in comparison to standard chemoimmunotherapy [bendamustine + rituximab (BR)]. We conducted a cost-effectiveness and budget impact analysis comparing VEN + R versus six comparators from the Swiss healthcare payer perspective. Methods A three-state partitioned survival model, developed in accordance with NICE and ISPOR decision modelling guidelines, was adapted to Switzerland. Model inputs were informed by the MURANO trial (survival data, patient characteristics), publicly available Swiss sources (drug prices, inpatient and outpatient costs), Swiss National Institute of Cancer Epidemiology and Registration data (incidence and prevalence values), and Swiss medical expert feedback. We used published (dis-)utility values and adverse event probabilities. Results Over a lifetime, VEN + R resulted in an expected gain of 2.60 quality-adjusted life years (QALYs) per patient and incremental costs of Swiss Francs (CHF) 147,851 compared to BR, leading to an incremental cost-effectiveness ratio of CHF 56,881/QALY gained. Other treatment strategies (for example ibrutinib versus VEN + R) resulted in higher costs and lower QALYs. Results were not different for subgroups of patients with/without deletion of chromosome 17p/tumour protein 53 mutation. In scenario analysis, changes in post-progression treatment costs demonstrated a high impact on results. We estimated an expected value of perfect information of CHF 3,318/patient. A moderate VEN + R uptake was estimated to save CHF 12.3 million during 5 years. Conclusions Using a threshold of CHF 100,000 per QALY, VEN + R was projected to be cost-effective vs BR.

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A cost-effectiveness analysis of consolidation immunotherapy with durvalumab in stage III NSCLC responding to definitive radiochemotherapy in Switzerland

Cited by 20 publications

References 10 publications

Cost Effectiveness of Durvalumab in Unresectable Stage III NSCLC: 4-Year Survival Update and Model Validation from a UK Healthcare Perspective

Cost Effectiveness of Durvalumab in Unresectable Stage III NSCLC: 4-Year Survival Update and Model Validation from a UK Healthcare Perspective

Identification of Gene Markers for Survival Prediction of Lung Adenocarcinoma Patients Based on Integrated Multibody Data Analysis

Cost-effectiveness and budget impact of venetoclax in combination with rituximab in relapsed/refractory chronic lymphocytic leukemia in Switzerland

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