Cost-Effectiveness of Durvalumab After Chemoradiotherapy in Unresectable Stage III NSCLC: A US Healthcare Perspective

Abstract

Background: Durvalumab was approved by the FDA in February 2018 for patients with unresectable stage III NSCLC that has not progressed after platinum-based concurrent chemoradiotherapy (cCRT), and this regimen is the current standard of care. The objective of this study was to examine the cost-effectiveness of durvalumab following cCRT versus cCRT alone in patients with locally advanced, unresectable stage III NSCLC. Methods: A 3-state semi-Markov model was used. Modeling was performed in a US healthcare setting from Medicare and commercial payer perspectives over a 30-year time horizon. Clinical efficacy (progression-free and post progression survival) and utility inputs were based on PACIFIC study data (ClinicalTrials.gov identifier: NCT02125461; data cutoff March 22, 2018). Overall survival extrapolation was validated using overall survival data from a later data cutoff (January 31, 2019). The main outcome was the incremental cost-effectiveness ratio (ICER) of durvalumab following cCRT versus cCRT alone, calculated as the difference in total costs between treatment strategies per quality-adjusted life-year (QALY) gained. Results: In the base-case analysis, durvalumab following cCRT was cost-effective versus cCRT alone from Medicare and commercial insurance perspectives, with ICERs of $55,285 and $61,111, respectively, per QALY gained. Durvalumab was thus considered cost-effective at the $100,000 willingness-to-pay (WTP) threshold. Sensitivity analyses revealed the model was particularly affected by variables associated with subsequent treatment, although no tested variable increased the ICER above the WTP threshold. Scenario analyses showed the model was most sensitive to assumptions regarding time horizon, treatment effect duration, choice of fitted progression-free survival curve, subsequent immunotherapy treatment duration, and use of a partitioned survival model structure. Conclusions: In a US healthcare setting, durvalumab was cost-effective compared with cCRT alone, further supporting the adoption of durvalumab following cCRT as the new standard of care in patients with unresectable stage III NSCLC.

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

“…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.…”

Cost-effectiveness analysis of durvalumab as a maintenance treatment for patients with locally advanced, unresectable, stage Ⅲ nsclc in china

“…Till now, there has not been any economic research on durvalumab in China, and a total of 6 economic studies on durvalumab versus BSC have been retrieved out of China, with 3 from US and 1 each from Switzerland, Italy and UK [11][12][13][14][15][16]. The clinical data of these six studies were obtained from PACIFIC study with the same control group of BSC (Table 4).…”

“…These studies were varied in the target population, study perspectives, models, clinical background and resources of cost data, hence different conclusions were drawn. The US study [11] US study [12] US study [13] Switzerland study [14] Italy study [15] UK study [16] Present study �…”

“…Safety data showed that the use of durvalumab in addition to definitive chemoradiation therapy did not significantly increase the incidence of adverse reaction events. To date, there are 6 studies on economic evaluation of durvalumab conducted out of China, which might be different in the study perspectives, models and resources of cost data, thus varied in conclusions [11][12][13][14][15][16]. No studies on cost-effectiveness of durvalumab has been found in China yet, therefore, the purpose of this study is to evaluate the cost-effectiveness of durvalumab versus best supportive care (BSC) for patients with unresectable, stage III NSCLC in China based on the cost data of in China and the effectiveness data from subpopulation analysis of Asian ethnicity in PACIFIC study (January 31, 2019, data cut-off), so as to provide reference for the dynamic adjustment of Chinese medical insurance catalogues and the negotiation of market exclusivity for durvalumab.…”

Immunotherapy for Stage III NSCLC: Durvalumab and Beyond

“…Multiple studies have demonstrated the cost-effectiveness of durvalumab, and although funding varies across different countries, the overall conclusion is that durvalumab consolidation treatment is cost-effective compared to combined chemoradiotherapy alone, accentuating the importance of increased access. [68][69][70] Cost-effectiveness analysis has shown no consolidation therapy resulted in a mean cost of US $185,944 and mean quality-adjusted life-years of 2.34. Durvalumab consolidation increased quality-adjusted lifeyears to 2.57, with an increase in mean cost to $201,563.…”