Presentation (CTI)

OBJECTIVES: Small cell lung cancer (SCLC) is an aggressive lung cancer subtype characterised by rapid growth and early metastasis. Treatment options for patients with second-line or later (2L+) disease remain limited and largely unchanged for over 15 years, resulting in substantial unmet need. Three systematic literature reviews (SLRs) aimed to identify, synthesise, and critically appraise evidence on cost-effectiveness, health-state utility values (HSUVs), and healthcare costs and resource use (HCRU) for 2L+ SCLC.
METHODS: SLRs were conducted in accordance with a pre-specified protocol and University of York Centre for Reviews and Dissemination methodology. Electronic databases (MEDLINE, Embase, NHS Economic Evaluation Database, Health Technology Assessment Database) were searched from April 2023 to October 2025, supplemented by HTA agency websites, economic evidence repositories, conference proceedings, and bibliographies of relevant SLRs, network meta-analyses, HTAs and economic evaluations (EEs). EEs, HSUVs, and HCRU studies in relapsed/refractory SCLC following platinum-based chemotherapy were eligible for inclusion. Abstract screening, full-text screening, and data extraction were performed independently by two reviewers.
RESULTS: Twenty-eight unique studies were identified: 11 EEs, two HSUV studies, 15 HCRU studies. Among EEs, seven used partitioned survival models, three Markov models and one survival-model framework. Results varied substantially across countries, reflecting differing cost-effectiveness thresholds, and were highly sensitive to survival extrapolation, post-progression utilities, and drug costs. Both HSUV studies used EQ-5D in real-world settings, with utilities showing only mild-to-moderate correlation with symptoms and toxicities, suggesting EQ-5D may not fully capture SCLC-specific health states. HCRU analyses drew on multiple real-world data sources, showing increasing resource use in later therapy lines, primarily driven by drug acquisition, inpatient and outpatient care costs.
CONCLUSIONS: These SLRs demonstrate high economic burden in 2L+ SCLC, but evidence is limited and heterogeneous, with substantial uncertainty hindering cross-study comparisons. Future research should prioritise comparative studies with standardised outcomes to improve clinical and economic decision-making.