PCN48 Cost-Benefit Analysis of Trilaciclib for the Prevention of Chemotherapy-Induced Myelosuppression in Extensive-Stage Small Cell Lung Cancer

Abstract

Evaluate the net monetary benefit (NMB) of trilaciclib when used to prevent chemotherapy-induced myelosuppression (CIM) in patients with extensive-stage small cell lung cancer (ES-SCLC). A decision tree model was constructed to calculate the NMB associated with trilaciclib, a myelopreservation therapy. Health outcomes and related economic consequences were projected and compared for adult patients receiving trilaciclib or placebo prior to treatment with standard first-line (etoposide, carboplatin, and atezolizumab) or second-line (topotecan) anticancer regimens. Rates of hematologic adverse events (AEs) consequent to CIM and their reduction due to trilaciclib were imputed from trilaciclib clinical trials. Drug expenses were calculated from published wholesale acquisition costs at recommended dosing. AE management costs were obtained from published literature. Quality-of-life measures were derived from patient-reported outcomes data collected in trilaciclib clinical trials, and quality-adjusted-life-year (QALY) was transformed into a monetary value using willingness-to-pay thresholds. The time horizon was set to the duration of each chemotherapy-based regimen during which CIM events were observed. Assumptions and uncertainty in model parameters were tested using sensitivity analyses. Evaluations were undertaken from a US payer perspective and expressed in 2019 USD. Incremental budget expenses associated with add-on trilaciclib therapy were offset by savings attributed to a reduction in the incidence and costs of patients’ CIM-related AEs. Overall healthcare costs were estimated to be $15,014 and $19,642 lower for both first- and second-line recipient populations, respectively. In parallel, the NMB of trilaciclib was computed to be $15,244 and $21,081 for each corresponding cohort at a conservative $50,000/QALY willingness-to-pay when given as a preemptive intervention. Our model predicts the use of trilaciclib prior to chemotherapy leads to positive NMB in patients with ES-SCLC owing to downstream improvements in QALY and reduced healthcare costs. Economically, trilaciclib is a favorably valued innovation for preventing myelosuppression in patients with ES-SCLC.