COST-EFFECTIVENESS OF FIRST-LINE IMMUNOTHERAPY-BASED REGIMENS FOR NON-SMALL CELL LUNG CANCER IN JAPAN
Author(s)
Kensuke Moriwaki, BS, MS, PhD1, Ryutaro Sakai, MS2, Seiya Taniguchi, MS2, Mao Yamaguchi, MS3.
1Associate Professor, Ritsumeikan University, Kyoto, Japan, 2Ritsumeikan University, Kusatsu, Japan, 3Ritsumeikan university, Kusatsu, Japan.
1Associate Professor, Ritsumeikan University, Kyoto, Japan, 2Ritsumeikan University, Kusatsu, Japan, 3Ritsumeikan university, Kusatsu, Japan.
OBJECTIVES: To evaluate the relative cost-effectiveness of first-line pharmacotherapies for non-small cell lung cancer (NSCLC) available in Japan.
METHODS: A partitioned survival analysis model was developed based on the POSEIDON trial, comparing chemotherapy (chemo) alone, durvalumab (durva) plus chemo, and durva plus tremelimumab (treme) plus chemo. Survival curves for atezolizumab (atezo) monotherapy, pembrolizumab (pembro) plus chemo, and nivolumab (nivo) plus chemo were extrapolated from the POSEIDON chemo arm using hazard ratios from a published network meta-analysis. Log-logistic distributions were applied for parametric survival extrapolation. Drug costs were based on the listed prices at the time of market authorization in Japan. A lifetime horizon, 2% discount rate, and Japanese payer perspective were applied. Probabilistic sensitivity analysis (PSA) was conducted.
RESULTS: Durva-based regimens were subject to extended dominance. The efficiency frontier comprised chemo (reference), atezo monotherapy (ICER: 43,870,350 JPY/QALY vs. chemo), pembro plus chemo (sequential ICER: 50,820,746 JPY/QALY), and nivo plus chemo (sequential ICER: 108,528,461 JPY/QALY). At the willingness-to-pay (WTP) threshold of 15,000,000 JPY/QALY, no immunotherapy regimen was cost-effective (probability of cost-effectiveness: chemo = 1.00). PSA showed atezo and pembro plus chemo became the most acceptable options at WTP of approximately 45,000,000 and 55,000,000 JPY/QALY, respectively.
CONCLUSIONS: No first-line immunotherapy regimen was cost-effective at Japan's current WTP threshold. The gap between the estimated ICERs and the societal WTP was substantial for all regimens, particularly for nivo plus chemo. These findings are relevant in the context of Japan's cost-effectiveness evaluation system, which may trigger price adjustments for high-cost drugs. Atezo monotherapy and pembro plus chemo showed comparatively favorable profiles among the immunotherapy options, and could become cost-effective if drug prices were reduced to align incremental costs with societal WTP. Policymakers and manufacturers should consider value-based pricing strategies to improve patient access to effective first-line NSCLC treatments.
METHODS: A partitioned survival analysis model was developed based on the POSEIDON trial, comparing chemotherapy (chemo) alone, durvalumab (durva) plus chemo, and durva plus tremelimumab (treme) plus chemo. Survival curves for atezolizumab (atezo) monotherapy, pembrolizumab (pembro) plus chemo, and nivolumab (nivo) plus chemo were extrapolated from the POSEIDON chemo arm using hazard ratios from a published network meta-analysis. Log-logistic distributions were applied for parametric survival extrapolation. Drug costs were based on the listed prices at the time of market authorization in Japan. A lifetime horizon, 2% discount rate, and Japanese payer perspective were applied. Probabilistic sensitivity analysis (PSA) was conducted.
RESULTS: Durva-based regimens were subject to extended dominance. The efficiency frontier comprised chemo (reference), atezo monotherapy (ICER: 43,870,350 JPY/QALY vs. chemo), pembro plus chemo (sequential ICER: 50,820,746 JPY/QALY), and nivo plus chemo (sequential ICER: 108,528,461 JPY/QALY). At the willingness-to-pay (WTP) threshold of 15,000,000 JPY/QALY, no immunotherapy regimen was cost-effective (probability of cost-effectiveness: chemo = 1.00). PSA showed atezo and pembro plus chemo became the most acceptable options at WTP of approximately 45,000,000 and 55,000,000 JPY/QALY, respectively.
CONCLUSIONS: No first-line immunotherapy regimen was cost-effective at Japan's current WTP threshold. The gap between the estimated ICERs and the societal WTP was substantial for all regimens, particularly for nivo plus chemo. These findings are relevant in the context of Japan's cost-effectiveness evaluation system, which may trigger price adjustments for high-cost drugs. Atezo monotherapy and pembro plus chemo showed comparatively favorable profiles among the immunotherapy options, and could become cost-effective if drug prices were reduced to align incremental costs with societal WTP. Policymakers and manufacturers should consider value-based pricing strategies to improve patient access to effective first-line NSCLC treatments.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE60
Topic
Economic Evaluation
Disease
SDC: Oncology