US PAYER COST-OF-CARE ANALYSIS FOR DURVALUMAB IN COMBINATION WITH ETOPOSIDE/PLATINUM VS ATEZOLIZUMAB-BASED REGIMENS IN 1L ES-SCLC SETTING
Author(s)
William Wang, MSc1, Jonathan Gbolahan, MSc2, Rebeca Mora, MD2, Tiffany Varughese, PharmaD2, Victor Genestier, MSc3;
1AstraZeneca, Mississauga, ON, Canada, 2AstraZeneca, Gaithersburg, MD, USA, 3Amaris Consulting, Toronto, ON, Canada
1AstraZeneca, Mississauga, ON, Canada, 2AstraZeneca, Gaithersburg, MD, USA, 3Amaris Consulting, Toronto, ON, Canada
OBJECTIVES: To evaluate the 1st year economic burden of treating newly diagnosed ES-SCLC patients in the 1st-line with durvalumab+etoposide/platinum (EP) versus atezolizumab+EP, and atezolizumab+EP with maintenance lurbinectedin+atezolizumab from the US Medicare and commercial payer perspectives.
METHODS: A cost-of-care analysis for Medicare and commercial plans using a 1-year time horizon. A hypothetical 1,000,000-member plan, after applying age stratified (18-64; ≥65) ES-SCLC incidence and 1L treatment eligibility assumptions, generated ES-SCLC cases (8 per million for commercial; 90 per million for Medicare). Efficacy and safety inputs were drawn from the CASPIAN, IMpower133, and IMforte trials and applied restricted mean survival to reflect treatment duration, progression, and associated resource use to account for patients who die within the 1-year modeled period. Cost components included drug acquisition and administration, health care resource utilization (HCRU), grade ≥3 adverse event management, and subsequent therapy.
RESULTS: Across both perspectives, durvalumab+EP was associated with the lowest overall costs. In Medicare, total per patient costs were the lowest for durvalumab + EP ($135,844), compared with atezolizumab+EP ($140,101), and lurbinectedin+atezolizumab maintenance ($156,137). Durvalumab+EP also had the lowest drug acquisition costs ($97,443 vs. $98,116 and $126,693). In commercial plans, per-patient total costs were also lowest for durvalumab+EP ($234,347), versus the comparators ($245,025 and $240,813), with durvalumab+EP again showing the lowest drug acquisition costs ($98,339 vs. $103,685 and $131,288). Cost savings were primarily driven by drug acquisition costs, with durvalumab+EP accounting for savings of $4,257-$20,293 per Medicare patient and $965-$10,679 per commercial patient.
CONCLUSIONS: This analysis demonstrated that durvalumab+EP was consistently the least costly 1L ES-SCLC option for Medicare and commercial perspectives in the first year of treatment, driven predominantly by lower drug acquisition costs.
METHODS: A cost-of-care analysis for Medicare and commercial plans using a 1-year time horizon. A hypothetical 1,000,000-member plan, after applying age stratified (18-64; ≥65) ES-SCLC incidence and 1L treatment eligibility assumptions, generated ES-SCLC cases (8 per million for commercial; 90 per million for Medicare). Efficacy and safety inputs were drawn from the CASPIAN, IMpower133, and IMforte trials and applied restricted mean survival to reflect treatment duration, progression, and associated resource use to account for patients who die within the 1-year modeled period. Cost components included drug acquisition and administration, health care resource utilization (HCRU), grade ≥3 adverse event management, and subsequent therapy.
RESULTS: Across both perspectives, durvalumab+EP was associated with the lowest overall costs. In Medicare, total per patient costs were the lowest for durvalumab + EP ($135,844), compared with atezolizumab+EP ($140,101), and lurbinectedin+atezolizumab maintenance ($156,137). Durvalumab+EP also had the lowest drug acquisition costs ($97,443 vs. $98,116 and $126,693). In commercial plans, per-patient total costs were also lowest for durvalumab+EP ($234,347), versus the comparators ($245,025 and $240,813), with durvalumab+EP again showing the lowest drug acquisition costs ($98,339 vs. $103,685 and $131,288). Cost savings were primarily driven by drug acquisition costs, with durvalumab+EP accounting for savings of $4,257-$20,293 per Medicare patient and $965-$10,679 per commercial patient.
CONCLUSIONS: This analysis demonstrated that durvalumab+EP was consistently the least costly 1L ES-SCLC option for Medicare and commercial perspectives in the first year of treatment, driven predominantly by lower drug acquisition costs.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE61
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Value of Information
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology