Abstract
BACKGROUND: The recently conducted ADRIATIC trial demonstrated that adding durvalumab led to significant improvements in the survival of non-advanced limited-stage small cell lung cancer (LS-SCLC) following concurrent chemoradiotherapy (CCRT). While efficacious, immunotherapeutic drugs are associated with high costs. Therefore, the purpose of this study is to conduct pharmacoeconomic analyses of the cost-effectiveness of durvalumab consolidation treatment after CCRT for LS-SCLC from the perspective of payers in specific countries. METHODS: The costs and efficacy of consolidation durvalumab versus placebo treatment following CCRT for LS-SCLC patients were analyzed using a three-state Markov model. The lifetime direct medical costs, incremental cost-effectiveness ratios (ICERs), incremental cost-utility ratios (ICURs), and incremental net-health benefit (INHB) associated with these treatment strategies were evaluated from the perspective of payers in China and the USA (the primary source countries for patients in the ADRIATIC trial) at respective willingness-to-pay (WTP) thresholds of $37,023 and $150,000 per quality-adjusted life-year (QALY). Sensitivity and subgroup analyses were used to assess model stability. RESULTS: Durvalumab consolidation was associated with 2.24 and 2.80 incremental QALYs relative to placebo for patients in China and the USA, but it was also associated with significant increases in lifetime medical costs ($48,511 vs. $18,769 and $403,946 vs. $154,579), for corresponding ICURs of $13,257/QALY and $89,079/QALY in China and the USA. Sensitivity analyses supported the stability of the established model, while subgroup analyses indicated that durvalumab consolidation was recommended within 2 weeks of CCRT. CONCLUSIONS: Durvalumab consolidation following CCRT represents a cost-effective option for the treatment of LS-SCLC patients in China and the USA.