Use of durvalumab after platinum-based chemoradiotherapy for the treatment of unresectable stage III non-small cell lung cancer (NSCLC) was more cost-effective than chemoradiotherapy alone for Medicare and commercial insurances based on quality-adjusted life-year (QALY) gains, according results from a study published in the Journal of the National Comprehensive Cancer Network.
This finding further supports “the adoption of durvalumab following concurrent chemoradiotherapy as the new standard of care in patients with unresectable stage III NSCLC,” the researchers said.
Durvalumab is approved by the US Food and Drug Administration for the treatment of unresectable, stage III NSCLC in patients whose disease has not progressed after concurrent platinum-based chemoradiotherapy. The approval was based on the survival benefit of durvalumab in the phase 3 PACIFIC trial in this population. The aim of this study was to evaluate the cost effectiveness of this regimen.
The modeling study used a 3-state semi-Markov model and data from Medicare and commercial payers in the US healthcare system over a 30-year time horizon. Data from the PACIFIC study were used for the clinical efficacy and utility inputs in the model. The primary endpoint was incremental cost-effectiveness ratio (ICER), which was calculated using the difference in total costs per QALY between chemoradiotherapy and chemoradiotherapy followed by durvalumab. Costs were standardized to 2018 values.
Although the addition of durvalumab resulted in higher total costs with Medicare ($206,818 vs $115,395) and commercial insurance ($244,582 vs $142,524) compared with chemoradiotherapy alone, durvalumab resulted in greater life years (LYs) and QALYs gained. In the progression-free state, durvalumab resulted in a gain of 2.37 LYs and 2.01 QALYs. The ICERs were $55,285 per QALY gained for Medicare and $61,111 for commercial insurance.
“The relatively high drug and administration costs associated with durvalumab were partly offset by lower discounted end-of-life and subsequent therapy costs,” noted the researchers.
They concluded that “our findings show that in a US healthcare setting, durvalumab following concurrent chemoradiotherapy is cost-effective compared with concurrent chemoradiotherapy alone.”
Disclosure: Multiple authors declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original article for a full list of disclosures.
Mehra R, Yong C, Seal B, van Keep M, Raad A, Zhang Y. Cost-effectiveness of durvalumab after chemoradiotherapy in unresectable stage III NSCLC: a US healthcare perspective. J Natl Compr Canc Netw. 2021;19(2):153-162. doi:10.6004/jnccn.2020.7621