Economic Evaluation of Tarlatamab as Second-Line Therapy for Metastatic Small-Cell Lung Cancer: A United States Perspective
Author(s)
Hanrui Zheng, Master1, Bin Wu, Master2, MING HU, PhD1.
1West China School of Pharmacy, Sichuan University, Chengdu, China, 2West China Hospital Sichuan University, Chengdu, China.
1West China School of Pharmacy, Sichuan University, Chengdu, China, 2West China Hospital Sichuan University, Chengdu, China.
Presentation Documents
OBJECTIVES: Tarlatamab significantly prolonged overall survival compared with chemotherapy for small cell lung cancer (ES-SCLC) patients progressing during or after platinum-based chemotherapy. This study aimed to evaluate the cost-effectiveness of tarlatamab compared to chemotherapy as a second-line treatment for ES-SCLC from the perspective of the United States healthcare system.
METHODS: A partitioned survival model was constructed to simulate disease progression, based on the DeLLphi-304 trial study. The model adopted a 28-day cycle length and a 10-year time horizon. Individual patient-level data were reconstructed and extrapolated using R software to support survival analysis. Direct medical costs, including expenditures associated with medications, laboratory testing, follow-up treatments, best supportive care, management of adverse events, end-of-life care, and other healthcare-related services were considered. Drug prices were obtained from sourced from the Drug Price Guide, while health utility estimates were extracted from previously published studies. The incremental cost-effectiveness ratio (ICER) served as the primary economic outcome, with model outputs also including total and incremental costs, as well as quality-adjusted life years (QALYs) and incremental QALYs. A willingness-to-pay (WTP) threshold was set at $150,000.00/QALY for the United States One-way sensitivity analysis and probabilistic sensitivity analyses were conducted to evaluate the robustness of the model outcomes.
RESULTS: Treatment with tarlatamab yielded an additional 0.79 QALYs compared to chemotherapy, at an incremental cost of $204,302.17. This resulted in an ICER of $704,490.24 per QALY, which substantially exceeds the WTP threshold. The cost of tarlatamab emerged as a major influential parameter in the sensitivity analyses, demonstrating a substantial impact on the cost-effectiveness outcomes.
CONCLUSIONS: At a WTP threshold of $150,000/QALY, tarlatamab was not considered a cost-effective option compared to chemotherapy for the treatment of recurrent ESCLC from the U.S. payer perspective.
METHODS: A partitioned survival model was constructed to simulate disease progression, based on the DeLLphi-304 trial study. The model adopted a 28-day cycle length and a 10-year time horizon. Individual patient-level data were reconstructed and extrapolated using R software to support survival analysis. Direct medical costs, including expenditures associated with medications, laboratory testing, follow-up treatments, best supportive care, management of adverse events, end-of-life care, and other healthcare-related services were considered. Drug prices were obtained from sourced from the Drug Price Guide, while health utility estimates were extracted from previously published studies. The incremental cost-effectiveness ratio (ICER) served as the primary economic outcome, with model outputs also including total and incremental costs, as well as quality-adjusted life years (QALYs) and incremental QALYs. A willingness-to-pay (WTP) threshold was set at $150,000.00/QALY for the United States One-way sensitivity analysis and probabilistic sensitivity analyses were conducted to evaluate the robustness of the model outcomes.
RESULTS: Treatment with tarlatamab yielded an additional 0.79 QALYs compared to chemotherapy, at an incremental cost of $204,302.17. This resulted in an ICER of $704,490.24 per QALY, which substantially exceeds the WTP threshold. The cost of tarlatamab emerged as a major influential parameter in the sensitivity analyses, demonstrating a substantial impact on the cost-effectiveness outcomes.
CONCLUSIONS: At a WTP threshold of $150,000/QALY, tarlatamab was not considered a cost-effective option compared to chemotherapy for the treatment of recurrent ESCLC from the U.S. payer perspective.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE387
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Trial-Based Economic Evaluation
Disease
Oncology