153P Safety profile and associated costs of therapies for relapsed small cell lung cancer in Switzerland

Abstract

Small cell lung cancer (SCLC) is an aggressive disease with poor prognosis, in particular in the relapsed setting. Treatments for relapsed SCLC remain limited with no new recent approvals in Europe. Lurbinectedin was granted FDA accelerated approval for patients with SCLC with disease progression after platinum containing therapy. Differences exist with respect to adverse events (AE) among therapies for 2LSCLC. Our aim was to compare the cost of managing adverse events in 2L treatment of SCLC with recommended therapies and with lurbinectedin in Switzerland. The relevance of guideline-adherent comparators in routine clinical practice was verified by Swiss clinical expert opinion. AE ≥ grade 3 related to treatment were derived from RCTs of 2L SCLC with topotecan (oral and IV), CAV (cyclophosphamide + doxorubicin + vincristine), etoposide + carboplatin and from the phase II B-005 trial of lurbinectedin monotherapy in 2LSCLC. Resource use and unit costs were obtained from published literature, national tariffs and clinical expert opinion. Scenario analysis with upper and lower limits of incidence of AEs and costs associated with each AE were constructed. Base case results for costs of AE management were CHF 9,238 (€8,421) per patient per treatment course (typically 4 cycles) for oral topotecan, CHF 8,608 (€7,847) for IV topotecan; CHF 5,155 (€4,699) for etoposide plus carboplatin, CHF 4,942 (€ 4,505) for CAV and CHF 1,346 (€1,227) for lurbinectedin. Scenario analyses: lower limit (LL) CHF 1,067 (€973) for lurbinectedin, CHF 2,716 (€2,476)-CHF 5,582 (€5,088) for standard treatments. Upper limit (UL) CHF 1,625 (€1,481) for lurbinectedin, CHF 5,853 (€5,335)-CHF 12,895 (€11,755) for standard treatments. The most frequently used treatments for 2L SCLC in Switzerland are carboplatin + etoposide and CAV, followed by IV topotecan. On average, lurbinectedin was associated with cost savings of 81% (74%-85%) compared to standard treatments. A subanalysis limited to recent trials (published 2020-2021) showed reproducibility of results. Lurbinectedin is associated with substantially lower cost for AE treatment compared to existing 2L SCLC treatments in Switzerland.