Cost-Effectiveness Analysis of Durvalumab and Atezolizumab With Chemotherapy Versus Chemotherapy Alone for First-Line Treatment of Extensive-Stage Small-Cell Lung Cancer in Taiwan
Author(s)
Shu-Hua Chan, M.S., Ming-Neng Shiu, Ph.D..
National Yang Ming Chiao Tung University, Department of Pharmacy, Taipei, Taiwan.
National Yang Ming Chiao Tung University, Department of Pharmacy, Taipei, Taiwan.
Presentation Documents
OBJECTIVES: The study assessed the cost-effectiveness of durvalumab + chemotherapy (DEP), atezolizumab + chemotherapy (AEB), and chemotherapy alone (EP) for patients with extensive-stage small cell lung cancer (ES-SCLC) from Taiwan's National Health Insurance (NHI) perspective.
METHODS: A three-state partitioned survival model was developed with a 10-year time horizon to compare three treatments: DEP, AEB, and EP. In the absence of head-to-head comparisons, efficacy parameters were derived from network meta-analysis results on survival curves from IMpower133 and CASPIAN trials. The target population and associated direct medical cost was analyzed in a Taiwan nationwide database to estimate cost parameters. Utility parameters were sourced from literature on Taiwanese patients. Costs and quality-adjusted life years (QALYs) were discounted at an annual rate of 3.5%. The primary outcomes included the incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (INMB), evaluated against a willingness-to-pay (WTP) threshold of NTD 3,224,166 (three times the 2023 gross domestic product per capita). Model robustness was assessed through deterministic and probabilistic sensitivity analyses. Given the current reimbursement restrictions on immune checkpoint inhibitors, a scenario analysis was conducted to assess their impact on patients without brain metastases (BM).
RESULTS: EP, AEB, and DEP yielded 0.3, 0.37, and 0.39 QALYs at costs of NTD 988,532, 1,920,318, and 2,479,368, respectively. The incremental ICERs were NTD 13,311,232 for AEB vs. EP, NTD 16,564,847 for DEP vs. EP, and NTD 27,952,501 for DEP vs. AEB per QALY. Neither DEP nor AEB were cost-effective compared to EP or each other. Scenario analysis showed that restricting use to patients without BM did not affect the results.
CONCLUSIONS: The addition of durvalumab and atezolizumab to chemotherapy was not cost-effective, either alone or in comparison, for ES-SCLC patients under Taiwan’s NHI. Scenario analysis indicated that restricting use to patients without brain metastases had no significant impact.
METHODS: A three-state partitioned survival model was developed with a 10-year time horizon to compare three treatments: DEP, AEB, and EP. In the absence of head-to-head comparisons, efficacy parameters were derived from network meta-analysis results on survival curves from IMpower133 and CASPIAN trials. The target population and associated direct medical cost was analyzed in a Taiwan nationwide database to estimate cost parameters. Utility parameters were sourced from literature on Taiwanese patients. Costs and quality-adjusted life years (QALYs) were discounted at an annual rate of 3.5%. The primary outcomes included the incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (INMB), evaluated against a willingness-to-pay (WTP) threshold of NTD 3,224,166 (three times the 2023 gross domestic product per capita). Model robustness was assessed through deterministic and probabilistic sensitivity analyses. Given the current reimbursement restrictions on immune checkpoint inhibitors, a scenario analysis was conducted to assess their impact on patients without brain metastases (BM).
RESULTS: EP, AEB, and DEP yielded 0.3, 0.37, and 0.39 QALYs at costs of NTD 988,532, 1,920,318, and 2,479,368, respectively. The incremental ICERs were NTD 13,311,232 for AEB vs. EP, NTD 16,564,847 for DEP vs. EP, and NTD 27,952,501 for DEP vs. AEB per QALY. Neither DEP nor AEB were cost-effective compared to EP or each other. Scenario analysis showed that restricting use to patients without BM did not affect the results.
CONCLUSIONS: The addition of durvalumab and atezolizumab to chemotherapy was not cost-effective, either alone or in comparison, for ES-SCLC patients under Taiwan’s NHI. Scenario analysis indicated that restricting use to patients without brain metastases had no significant impact.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD283
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Oncology