Cost-effectiveness of durvalumab consolidation therapy in limited-stage small-cell lung cancer: A Chinese and U.S. payer perspective analysis
Chengjun Wang, Shixian Liu, Chuang Yang, Yihong Guo, Rongyu Zhang, Yunfei Wang, Yanan Song, Mingfei Liu, Ruolin Zhang, Tiantian Xuan, Wen Zhao, Jisheng LiABSTRACT
Background:
The ADRIATIC trial has established durvalumab as a new standard of care for limited-stage small-cell lung cancer (LS-SCLC) by showing significant survival benefits after chemoradiotherapy (CRT). In this study, the cost-effectiveness of this regimen was evaluated from Chinese and U.S. payer perspectives.
Methods:
A partitioned survival model was used to estimate the lifetime costs and quality-adjusted life-years (QALYs) of patients receiving durvalumab compared with placebo after CRT. Data were sourced from the ADRIATIC trial. Outcomes included incremental cost-effectiveness ratios (ICERs), with uncertainty assessed via deterministic and probabilistic sensitivity analyses (PSAs).
Results:
In the base-case analysis for China, the ICER was $136,209.12 per QALY, which exceeds the $40,334.05 willingness-to-pay (WTP) threshold. For the U.S., the ICER was $214,184.71 per QALY, which is higher than the $150,000 WTP threshold. However, under the Chinese patient assistance program (PAP), the ICER decreased to $18,495.23 per QALY, making it cost-effective. Subgroup analysis revealed cost-effectiveness only in the U.S. carboplatin subgroup (ICER: $139,909.75 per QALY). PSA confirmed a low probability of cost-effectiveness (0–5.33%) in base-case scenarios, which increased to 99.93% under the Chinese PAP.
Conclusion:
At present, durvalumab consolidation therapy is not considered cost-effective for LS-SCLC in either country at the current WTP threshold. However, the Chinese PAP renders it a cost-effective option, highlighting the critical role of pricing and patient access programs.