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Durvalumab consolidation treatment cost-effective for non-small cell lung cancer
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Consolidation therapy with durvalumab for patients with stage III non-small cell lung cancer represented a cost-effective use of an expensive immunotherapy, according to study published in JAMA Oncology.
Durvalumab (Imfinzi, AstraZeneca) was the first immunotherapy approved for the adjuvant treatment of patients with unresectable stage III NSCLC that did not progress after definitive chemoradiotherapy; however, whether it is cost-effective has been unknown.
“Given that almost 30% of patients with NSCLC are diagnosed as having stage III disease and the duration of treatment in the adjuvant setting can be up to 1 year, the adoption of durvalumab consolidation therapy after chemoradiotherapy could have a profound financial consequence on cancer treatment spending in the United States,” Steven D. Criss, BS, research associate at the Institute for Technology Assessment of Massachusetts General Hospital, and colleagues wrote. “Despite the proven effectiveness of immunotherapy drugs, much concern has been dedicated to the costs associated with these advanced treatments.”
Criss and colleagues sought to approximate survival and cost outcomes of patients with unresectable stage III NSCLC with no signs of progression after definitive chemoradiotherapy.
Researchers constructed a decision analytic microsimulation model with a 1-month Markov cycle length to assess different treatment regimens in the U.S. health care system. They evaluated two post-chemoradiotherapy strategies: no consolidation therapy until progression, vs. durvalumab consolidation treatment until progression or for no longer than 1 year.
Researchers estimated the possible budgetary effects of these regimens by applying the percentage of patients who were diagnosed as stage III and received chemoradiotherapy to the expected number of new NSCLC cases yearly for 2018 to 2022 to find total eligible patients. They then multiplied this value by the mean difference in annual cost between the regimens over these 5 years.
Researchers matched the simulated conditions to those of the PACIFIC phase 3 randomized clinical trial — data from which supported the approval of durvalumab — and practical treatment regimens for metastatic NSCLC.
All patient simulations began disease free after undergoing radical treatment with chemoradiotherapy and were followed as they advanced to first-treatment for metastatic disease, second-line treatment for metastatic disease, end-stage progressive disease and death.
The incremental cost-effectiveness ratio (ICER) of durvalumab consolidation therapy compared with no consolidation therapy — expressed as aggregate treatment cost per quality-adjusted life year (QALY) gained — served as the study’s primary outcome. The researchers compared the ICERs with a $100,000 per willingness-to-pay threshold.
Results showed that among 2 million simulated patients, a lack of consolidation therapy after chemoradiotherapy yielded a mean cost-per-patient of $185,944 and a mean quality-adjusted survival per patient of 2.34 QALYs.
Mean cost per patient for durvalumab consolidation therapy was $201,563 and mean quality-adjusted survival per patient was 2.57 QALYs. The estimated ICER was $67,421 per QALY.
In a budgetary consequence analysis, the researchers estimated 11,982 patients in the U.S. were eligible for durvalumab consolidation therapy in 2018. This eligibility depends on roughly 28.4% of a projected 198,926 NSCLC cases being diagnosed at stage III, and approximately 21.2% of these patients receiving chemoradiotherapy.
Researchers projected that implementing durvalumab consolidation treatment for all eligible U.S. patients would increase national cancer spending by $768 million in year 1, which would decrease to $241 million in year 5.
“Our study demonstrates that durvalumab consolidation therapy can be cost-effective for patients with unresectable, stage III NSCLC whose disease has not progressed after chemoradiotherapy,” the researchers wrote. “Given the substantial consequence on cancer spending that immunotherapy treatments will likely have, it is necessary to find indications where these therapies are of most value.” – by Jennifer Byrne
Disclosures : Criss reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Criss SD, et al. JAMA Oncol. 2018; doi:10.1001/jamaoncol.2018.5449.
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