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

Ding, Dong; Hu, Huabin; Li, Shuosha; Ying, Zhu; Yin, Shi; Liao, Mengting; Liu, Jin; Xu, Tao; Liu, Aiting; Huang, Jin

doi:10.6004/jnccn.2020.7796

Cited by 33 publications

(78 citation statements)

References 44 publications

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“…Based on these clinical trials, published research studied the cost-effectiveness of new immunotherapy strategies. According to the data of CASPIAN trial, our published research [ 33 ] demonstrated that durvalumab in combination with platinum–etoposide was not a cost-effective option in the first-line treatment of patients with extensive-stage SCLC in the U.S. According to the data of Impower133 trial, Qiu Li [ 34 ] and Li [ 15 ] conducted cost-effectiveness analysis and concluded that atezolizumab plus chemotherapy to chemotherapy was not a cost-effective choice in the first-line treatment of extensive-stage SCLC from an American and Chinese perspective, respectively.…”

Section: Discussionmentioning

confidence: 99%

First-line pembrolizumab plus chemotherapy for extensive-stage small-cell lung cancer: a United States-based cost-effectiveness analysis

Ying

Ding

et al. 2021

Cost Eff Resour Alloc

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Background The clinical trial of Keynote-604 showed that pembrolizumab plus chemotherapy could generate clinical benefits for extensive-stage small-cell lung cancer (ES-SCLC). We aim to assess the efficacy and cost of pembrolizumab combined with chemotherapy in the first-line treatment setting of ES-SCLC from the United States (US) payers’ perspective. Methods A synthetical Markov model was used to evaluate cost and effectiveness of pembrolizumab plus platinum-etoposide(EP) versus EP in first-line therapy for ES-SCLC from the data of Keynote-604. Lifetime costs life-years(LYs), quality adjusted LYs(QALYs) and incremental cost-effectiveness ratios(ICERs) were estimated. One-way and probabilistic sensitivity analyses were performed. Furthermore, we performed subgroup analysis. Results Pembrolizumab plus EP resulted in additional 0.18 QALYs(0.32 LYs) and corresponding incremental costs $113,625, resulting an ICER of $647,509 per QALY versus EP. The price of pembrolizumab had a significant impact on ICER. Probabilistic sensitivity analysis indicated that pembrolizumab combined chemotherapy may become a cost-effective option with a probability of 0%. Besides, subgroup analysis suggested that all subgroups were not cost-effective. Conclusion From the perspective of the US payer, pembrolizumab plus EP is not a cost-effective option for first-line treatment patients with ES-SCLC at a WTP threshold of $150,000 per QALY.

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Section: Discussionmentioning

confidence: 99%

First-line pembrolizumab plus chemotherapy for extensive-stage small-cell lung cancer: a United States-based cost-effectiveness analysis

Ying

Ding

et al. 2021

Cost Eff Resour Alloc

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“…The Markov cycle length was set at 6 weeks, with a 10-years horizon, based on the treatment regimen and expected survival time of R/M NPC patients. All costs, as well as health outcomes, were discounted by 3% annually ( Ding et al, 2021 ). We chose the total expenses, quality-adjusted life-years (QALYs), life-years (LYs), and incremental cost-effectiveness ratios (ICERs) as primary endpoints with a willingness-to-pay threshold of $$35,673 per QALY (3 × capita gross domestic product of China in 2020) ( Xiao et al, 2017 ).…”

Section: Methodsmentioning

confidence: 99%

“…We executed univariable sensitivity assessments to indicate the uncertainty and impact of the parameters among the treatment alternatives using the available evidence. Univariable sensitivity analysis evaluated specific parameters in JUPITER-02 and CAPTAIN-first trials and 20% variation from baseline values ( Ding et al, 2021 ). Probabilistic sensitivity analysis was performed to characterize the current decision uncertainties.…”

Section: Methodsmentioning

confidence: 99%

Chemo-Immunotherapy Regimes for Recurrent or Metastatic Nasopharyngeal Carcinoma: A Network Meta-Analysis and Cost-Effectiveness Analysis

et al. 2022

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Introduction: In 2021, two phase III clinical trials confirmed that toripalimab or camrelizumab combined with gemcitabine and cisplatin (TGP or CGP) provide more benefits in the first-line treatment of R/M NPC than GP. Fortunately, TGP and CGP were recently approved as first-line treatments for cases experiencing R/M NPC by the China National Medical Products Administration in 2021. However, due to the high cost and variety of treatment options, the promotion of chemo-immunotherapeutics in the treatment of R/M NPC remains controversial. Therefore, we performed a cost-effectiveness assessment of the two newly approved treatment strategies to assess which treatments provide the greatest clinical benefits at a reasonable cost.Methods: A cost-effectiveness analysis and network meta-analysis network meta-analysis was conducted based on the JUPITER-02 and CAPTAIN-first Phase 3 randomized clinical trials. A Markov model was expanded for the evaluation of the effectiveness and cost of TGP, CGP, and GP chemotherapy with a 10-years horizon and measured the health achievements in quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and life-years (LYs). We constructed a treatment strategy and other parameters based on two clinical trials and performed one-way and probabilistic sensitivity experiments for the evaluation of the uncertainty in the model.Results: For the model of patients with treatment-R/M NPC, TGP was associated with a total cost of $48,525 and 2.778 QALYs (4.991 LYs), leading to an ICER of $15,103 per QALY ($10,321 per LY) compared to CGP. On comparing the GP chemotherapy, we found TGP and CGP incurred substantial health costs, resulting in ICERs of $19,726 per QALY and $20,438 per QALY, respectively. The risk of adverse events (AEs) and the price of the drugs had significant impacts on the ICER. At the assumed willingness-to-pay (WTP) threshold of $35,673 per QALY, there were approximately 75.8 and 68.5% simulations in which cost-effectiveness was achieved for TGP and CGP, respectively.Conclusion: From the Chinese payer’s perspective, TGP is more possible to be a cost-effective regimen compared with CGP and GP for first-line treatment of patients with R/M NPC at a WTP threshold of $35,673 per QALY.

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“…All prices are expressed in US dollars, using the exchange rate $1 =￥6.3389 (March 14, 2022). Based on our consumer price index and a discount rate of 3% per year, healthcare-related costs were inflated to 2022 values in China ( 22 ) ( Table 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…Sensitivity analyses were applied to resolve uncertainties in the model. One-way sensitivity analysis included relevant parameters and 20% variation ranges, and the probability sensitivity analysis involved 10,000 Monte Carlo simulations to obtain an acceptable curve ( 22 ).…”

Section: Methodsmentioning

confidence: 99%

Vascular Endothelial Growth Factor Receptor Inhibitors in Chinese Patients With Advanced Radioactive Iodine-Refractory Differentiated Thyroid Cancer: A Network Meta-Analysis and Cost-Effectiveness Analysis

et al. 2022

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IntroductionTwo targeted drugs (apatinib and lenvatinib) show clinical efficacy in first-line treatment of Chinese patients with radioactive advanced iodine-refractory differentiated thyroid cancer (RAIR-DTC) and are recommended by the Chinese Society of Clinical Oncology guidelines. Considering the high clinical cost of long-term vascular endothelial growth factor receptor inhibitor administration and to determine which of the two targeted drugs is preferable, we opted to conduct a cost-effectiveness analysis (CEA) and network meta-analysis (NMA).Material and MethodsThe results of NMA and CEA included in the two phase III randomized clinical trials REALITY (NCT03048877) and Study-308 (NCT02966093), in which Bayesian NMA and CEA were performed on 243 and 149 Chinese patients, respectively, were retrieved. Overall survival and progression-free survival (PFS) for apatinib versus lenvatinib were determined by NMA. CEA involved the development of a 20-year Markov model to obtain the total cost and quality-adjusted life-years (QALYs), and this was followed by sensitivity and subgroup analyses.ResultsCompared with lenvatinib, apatinib therapy provided a 0.837 improvement in QALY and $6,975 reduction in costs. The hazard ratio of apatinib versus lenvatinib and the cost of the targeted drugs had a significant impact on the model. According to the sensitivity analysis, apatinib was more cost-effective and had no correlation with willingness-to-pay in China. Subgroup analysis showed that apatinib maintained PFS more economically.ConclusionNMA and CEA demonstrated that apatinib was more cost-effective compared to lenvatinib in the first-line treatment of Chinese RAIR-DTC patients.

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

Cited by 33 publications

References 44 publications

First-line pembrolizumab plus chemotherapy for extensive-stage small-cell lung cancer: a United States-based cost-effectiveness analysis

First-line pembrolizumab plus chemotherapy for extensive-stage small-cell lung cancer: a United States-based cost-effectiveness analysis

Chemo-Immunotherapy Regimes for Recurrent or Metastatic Nasopharyngeal Carcinoma: A Network Meta-Analysis and Cost-Effectiveness Analysis

Vascular Endothelial Growth Factor Receptor Inhibitors in Chinese Patients With Advanced Radioactive Iodine-Refractory Differentiated Thyroid Cancer: A Network Meta-Analysis and Cost-Effectiveness Analysis

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