Durvalumab consolidation therapy may cost a lot of upfront, but it may be worth it in the long run for some patients with stage III unresectable non-small cell lung cancer (NSCLC), according to a new study published in JAMA Oncology.1 Researchers reported that durvalumab consolidation therapy represents a circumstance in which an expensive immunotherapy may be considered cost-effective.
Steven Criss, the Institute for Technology Assessment, Massachusetts General Hospital, Boston, and colleagues found that treating patients with this immunotherapy earlier in the course of disease progression may provide significant value. Durvalumab was approved earlier this year for adjuvant treatment of patients with unresectable stage III NSCLC whose cancer has not progressed after definitive chemoradiotherapy. There has been concern about whether it is a cost-effective therapy.
Criss and colleagues employed a decision analytic microsimulation model among 2 million simulated patients. The researchers found that this treatment approach was cost-effective at a $100,000 per quality-adjusted life-year (QALY) willingness-to-pay threshold. Based on their analysis, the researchers concluded that using this treatment strategy for all eligible patients could add an additional $768 million to national cancer spending in the first 12 months of implementation, but would then decrease after year 1 to represent a spending increase of $241 million by year 5.
The researchers relied on data from the PACIFIC phase 3 randomized clinical trial (ClinicalTrials.gov Identifier: NCT02125461) and reasonable treatment strategies for metastatic NSCLC for their simulation analysis. They examined the incremental cost-effectiveness ratio of durvalumab consolidation therapy compared with placebo, given as aggregate cost of treatment per quality-adjusted life-year gained.
The authors wrote that greater efforts are needed to identify which patient populations may respond best to immunotherapy and experience the fewest adverse events to further reduce the overall financial burden imposed by high-priced immunotherapies.
- Criss SD, Mooradian MJ, Sheehan DF, et al. Cost-effectiveness and budgetary consequence analysis of durvalumab consolidation therapy vs no consolidation therapy after chemoradiotherapy in stage III non–small cell lung cancer in the context of the US health care system [published online December 13, 2018]. JAMA Oncol. doi:10.1001/jamaoncol.2018.5449