Cost-Effectiveness Analysis of Durvalumab Plus Chemotherapy in the First-Line Treatment of Extensive-Stage Small Cell Lung Cancer

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Dong Ding Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan;

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Huabin Hu Department of Medical Oncology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou;
Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou;

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Shuosha Li Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan;

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Youwen Zhu Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan;

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Yin Shi Department of Pharmacy, and

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Mengting Liao Department of Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan;

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Jin Liu School of Computer Science and Engineering, Central South University, Changsha;

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Xu Tian School of Computer Science and Engineering, Central South University, Changsha;

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Aiting Liu Hunan Healthcare Security Administration, Changsha; and

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Jin Huang Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan;
Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China.

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Background: In the CASPIAN trial, durvalumab + chemotherapy demonstrated significant improvements in overall survival compared with chemotherapy alone in patients with extensive-stage small cell lung cancer (SCLC). We aimed to assess the cost-effectiveness of durvalumab in patients with extensive-stage SCLC from the US healthcare system perspective. Patients and Methods: A comprehensive Markov model was adapted to evaluate cost and effectiveness of durvalumab combination versus platinum/etoposide alone in the first-line therapy of extensive-stage SCLC based on data from the CASPIAN study. The main endpoints included total costs, life years (LYs), quality-adjusted life-years (QALYs), and incremental cost-e-ectiveness ratios (ICERs). Model robustness was assessed with sensitivity analysis, and additional subgroup analyses were also performed. Results: Durvalumab + chemotherapy therapy resulted in an additional 0.27 LYs and 0.20 QALYs, resulting in an ICER of $464,711.90 per QALY versus the chemotherapy treatment. The cost of durvalumab has the greatest influence on this model. Subgroup analyses showed that the ICER remained higher than $150,000/QALY (the willingness-to-pay threshold in the United States) across all patient subgroups. Conclusions: Durvalumab in combination with platinum/etoposide is not a cost-effective option in the first-line treatment of patients with extensive-stage SCLC.

Submitted August 26, 2020; final revision received October 19, 2020; accepted for publication December 14, 2020. Published online August 4, 2021.

Author contributions: Study concept and design: Ding, Hu, Huang. Performed experiments: Ding, Li, Zhu, Shi, Liao, A. Liu. Data analysis and interpretation: Ding, Hu, Li, Zhu, J. Liu, Tian, Huang. Contributed reagents/materials/analysis tools: Huang. Manuscript preparation: Ding, Hu, Huang. Final approval of manuscript: All authors.

Disclosures: The authors have disclosed that they have no conflicts of interest with regard to the content of article. This manuscript is original and has not been previously published, nor has it been simultaneously submitted to any other journal.

Funding: This manuscript was supported by grants from the Hunan Natural Science Foundation of China (No. 2018JJ3852).

Correspondence: Jin Huang, PhD, Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China. Email: jinhuang@csu.edu.cn

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