Abstract
ObjectiveThis study aimed to assess the cost-effectiveness of two recently approved first-line chemo-immunotherapies [atezolizumab combined with etoposide and platinum (AEP) and durvalumab combined with etoposide and platinum (DEP)] for patients with extensive-stage small-cell lung cancer (ES-SCLC) in the United States.Material and MethodsA Markov model was built to compare the cost and effectiveness of AEP, DEP, and etoposide plus platinum (EP) over a 10-year time horizon. Clinical efficacy and safety data were extracted from the IMpower 133 and CASPIAN trials. Health state utilities were obtained from published literature. Costs were collected from an US payer perspective. Deterministic and probabilistic sensitivity analyses were used to explore the uncertainty bound to model parameters.ResultsFor the model cohort of adult patients with treatment-naive ES-SCLC, AEP was associated with marginal improved quality adjusted life years (QALYs) by 0.016 and reduced costs by $5,737 compared with DEP. When comparing the two chemo-immunotherapies with EP chemotherapy, AEP and DEP increased the QALYs by 0.162 QALYs and 0.146, respectively. However, both chemo-immunotherapies were associated with substantially health costs than EP, resulting in ICERs of $382,469 per QALY and $464,593 per QALY, respectively.ConclusionIn this cost-effectiveness study, first-line AEP represented a dominant treatment strategy compared with DEP. Despite neither first-line AEP nor first-line DEP was cost-effective compared with EP chemotherapy, AEP was able to provide a more efficient balance between incremental cost and QALY than DEP. When new combination therapies with remarkable effect become pivotal in the first-line treatment, the price reduction of these drugs may be essential to achieving cost-effectiveness.
Highlights
Small cell lung cancer (SCLC) contributes to approximately 14% of all lung malignancies [1, 2], and up to two thirds of patients diagnosed with SCLC are classified as having extensive-stage small-cell lung cancer (ES-SCLC) [3]
Atezolizumab was the first immune checkpoint inhibitors (ICIs) approved by the US Food and Drug Administration (FDA) in March 2019 to combine with etoposide plus platinum (EP) chemotherapy as a first-line option for treating ES-SCLC [9]
AEP, atezolizumab combined with etoposide and platinum; DEP, durvalumab combined with etoposide and platinum; EP, etoposide plus platinum; OS, overall survival; progression-free survival (PFS), progressionfree survival; PS, progressed survival
Summary
Small cell lung cancer (SCLC) contributes to approximately 14% of all lung malignancies [1, 2], and up to two thirds of patients diagnosed with SCLC are classified as having extensive-stage small-cell lung cancer (ES-SCLC) [3]. Atezolizumab was the first ICI approved by the US Food and Drug Administration (FDA) in March 2019 to combine with EP chemotherapy as a first-line option for treating ES-SCLC [9] The study underpinning this approval was a randomized phase III IMpower 133 trial (ClinicalTrials.gov number:NCT02763579) showing that the combination therapy of atezolizumab and EP chemotherapy significantly improved overall survival (OS) and progression-free survival (PFS) in patients with ES-SCLC compared with the standard-of-care EP chemotherapy [10]. Driven by this promising result, there is a growing interest in exploring novel chemo-immunotherapy. Durvalumab in combination with EP became the second chemo-immunotherapy approved for the first-line treatment for ES-SCLC [12]
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