A TOTAL COST OF CARE (TCOC) MODELING TOOL TO EVALUATE SECOND-LINE TREATMENT COSTS FOR PATIENTS WITH EXTENSIVE STAGE SMALL CELL LUNG CANCER (ES-SCLC)
Author(s)
Deb A. Profant, PhD1, Amy M. Nguyen, PhD1, Edyta Ryczek, BSc, MSc2, Hannah Palin, BSc2, Wayne Luan, MSc, MBA3, Mischka Moechtar, MSc3, Michelle L. James, MSc, PhD2, Kaylie Metcalfe, BSc, MSc2, Jennifer Shear, PharmD1;
1Jazz Pharmaceuticals, Palo Alto, CA, USA, 2Petauri Evidence, Bicester, United Kingdom, 3Turquoise Health, San Diego, CA, USA
1Jazz Pharmaceuticals, Palo Alto, CA, USA, 2Petauri Evidence, Bicester, United Kingdom, 3Turquoise Health, San Diego, CA, USA
OBJECTIVES: Second-line treatments for ES-SCLC vary in evidence maturity, economic data availability, and real-world use, posing challenges for decision-makers comparing therapies. We explored TCOC for second-line ES-SCLC treatment with lurbinectedin, tarlatamab, platinum rechallenge, or oral topotecan using a novel cost-comparison tool.
METHODS: A customizable TCOC model was constructed to estimate costs from a US payer (Medicare/commercial health plan) or institutional perspective using economic data from Turquoise Health (aggregated commercial negotiated rates between payers and providers) and noneconomic data from clinical trials or prescribing information (dosing, treatment duration, adverse event [AE] rates) due to insufficient real-world data for all treatments. Costs included pharmacy acquisition, administration/observation, prophylaxis/monitoring, and AE management across a median number of treatment cycles. The model assumed patients received 1 treatment type in the outpatient setting and all grade ≥3 AEs/grade ≥2 cytokine release syndrome AEs were independent, occurred in the first treatment cycle, and required inpatient stays. Commercial perspective results are presented.
RESULTS: Commercial payer per-patient-per-course total costs were highest for tarlatamab ($226,215), followed by topotecan ($107,127), lurbinectedin ($100,126), and platinum rechallenge ($18,181). Drug acquisition represented the largest cost component for tarlatamab ($212,171), lurbinectedin ($86,805), and topotecan ($71,500). Administration/observation costs were highest for tarlatamab ($6,673), then platinum rechallenge ($3,656), lurbinectedin ($1,160), and topotecan ($0). Prophylactic treatment/monitoring costs were highest for topotecan ($13,442), then platinum rechallenge ($7,036), lurbinectedin ($3,450), and tarlatamab ($865). Inpatient management of AEs cost $22,185 (topotecan), $8,711 (lurbinectedin), $6,507 (tarlatamab), and $5,191 (platinum rechallenge).
CONCLUSIONS: Total per-patient-per-course costs were lowest for platinum rechallenge and similar for lurbinectedin and oral topotecan; estimated tarlatamab costs were $126,089 higher than lurbinectedin. This TCOC model is limited by reliance on clinical trial data rather than real-world data and did not consider grade 1/2 AEs for cost estimation. The tool provides a novel, methodologically flexible approach for evaluating the economic implications of second-line ES-SCLC treatment.
METHODS: A customizable TCOC model was constructed to estimate costs from a US payer (Medicare/commercial health plan) or institutional perspective using economic data from Turquoise Health (aggregated commercial negotiated rates between payers and providers) and noneconomic data from clinical trials or prescribing information (dosing, treatment duration, adverse event [AE] rates) due to insufficient real-world data for all treatments. Costs included pharmacy acquisition, administration/observation, prophylaxis/monitoring, and AE management across a median number of treatment cycles. The model assumed patients received 1 treatment type in the outpatient setting and all grade ≥3 AEs/grade ≥2 cytokine release syndrome AEs were independent, occurred in the first treatment cycle, and required inpatient stays. Commercial perspective results are presented.
RESULTS: Commercial payer per-patient-per-course total costs were highest for tarlatamab ($226,215), followed by topotecan ($107,127), lurbinectedin ($100,126), and platinum rechallenge ($18,181). Drug acquisition represented the largest cost component for tarlatamab ($212,171), lurbinectedin ($86,805), and topotecan ($71,500). Administration/observation costs were highest for tarlatamab ($6,673), then platinum rechallenge ($3,656), lurbinectedin ($1,160), and topotecan ($0). Prophylactic treatment/monitoring costs were highest for topotecan ($13,442), then platinum rechallenge ($7,036), lurbinectedin ($3,450), and tarlatamab ($865). Inpatient management of AEs cost $22,185 (topotecan), $8,711 (lurbinectedin), $6,507 (tarlatamab), and $5,191 (platinum rechallenge).
CONCLUSIONS: Total per-patient-per-course costs were lowest for platinum rechallenge and similar for lurbinectedin and oral topotecan; estimated tarlatamab costs were $126,089 higher than lurbinectedin. This TCOC model is limited by reliance on clinical trial data rather than real-world data and did not consider grade 1/2 AEs for cost estimation. The tool provides a novel, methodologically flexible approach for evaluating the economic implications of second-line ES-SCLC treatment.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE143
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Trial-Based Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology, SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)