Cost-effectiveness of durvalumab consolidation therapy in limited-stage small-cell lung cancer: A Chinese and U.S. payer perspective analysis.

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.