Cost-Effectiveness Analysis of Dostarlimab Plus Chemotherapy As First-Line Treatment for Metastatic Non-Squamous Non-Small Cell Lung Cancer in Japan
Author(s)
Kureha Kawai1, Kensuke Moriwaki, BS, MS, PhD2, Kosuke MORIMOTO, BS, MS2, Munenobu Kashiwa, PhD2, Kojiro Shimozuma, PhD, MD2;
1Kusatsu, Japan, 2Ritsumeikan University, Kusatsu, Japan
1Kusatsu, Japan, 2Ritsumeikan University, Kusatsu, Japan
OBJECTIVES: Dostarlimab + chemotherapy (DCT) has been shown to be as effective as the standard of care, pembrolizumab + chemotherapy (PCT), in patients with metastatic non-squamous non-small cell lung cancer. However, dostarlimab is not approved in Japan and its cost-effectiveness is not necessarily clear. This study aimed to evaluate the cost-effectiveness of DCT from the payer's perspective in Japan.
METHODS: A partitioned survival analysis model was developed to predict cost and quality-adjusted life years (QALYs) in DCT and PCT groups. Survival data were derived from the PERLA phase II trial. Drug prices for dostarlimab were estimated based on foreign prices. Other cost parameters were estimated by using the JMDC claims database. Time horizon of 20 years and discount rate of 2% was applied. Utility weights were estimated based on previous studies. The incremental cost-effectiveness ratio (ICER) of DCT compared with PCT was estimated. Sensitivity analysis (SA) was performed to assess parameter uncertainty.
RESULTS: Compared with PCT, DCT incurred an additional cost of JPY31,302,585 and conferred an additional 0.877 QALY. This resulted in the ICER of JPY35,691,615/QALY gained. SA showed that the parameter with the largest influence was utility of DCT group in progression-free state, and the ICER ranged from JPY28,820,118 to JPY46,865,657/QALY. It was also suggested that the cost-effectiveness of DCT strongly depends on the verification of superiority in OS, which was not achieved in the PERLA Phase II trial.
CONCLUSIONS: Applying the willingness to pay threshold of JPY15 million/QALY and foreign drug price, DCT was not cost-effective compared to PCT. More refined analysis will require accumulation of evidence, including tracking of long-term OS data and identification of subgroups with potential for larger effects.
METHODS: A partitioned survival analysis model was developed to predict cost and quality-adjusted life years (QALYs) in DCT and PCT groups. Survival data were derived from the PERLA phase II trial. Drug prices for dostarlimab were estimated based on foreign prices. Other cost parameters were estimated by using the JMDC claims database. Time horizon of 20 years and discount rate of 2% was applied. Utility weights were estimated based on previous studies. The incremental cost-effectiveness ratio (ICER) of DCT compared with PCT was estimated. Sensitivity analysis (SA) was performed to assess parameter uncertainty.
RESULTS: Compared with PCT, DCT incurred an additional cost of JPY31,302,585 and conferred an additional 0.877 QALY. This resulted in the ICER of JPY35,691,615/QALY gained. SA showed that the parameter with the largest influence was utility of DCT group in progression-free state, and the ICER ranged from JPY28,820,118 to JPY46,865,657/QALY. It was also suggested that the cost-effectiveness of DCT strongly depends on the verification of superiority in OS, which was not achieved in the PERLA Phase II trial.
CONCLUSIONS: Applying the willingness to pay threshold of JPY15 million/QALY and foreign drug price, DCT was not cost-effective compared to PCT. More refined analysis will require accumulation of evidence, including tracking of long-term OS data and identification of subgroups with potential for larger effects.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE374
Topic
Economic Evaluation
Disease
SDC: Oncology