OBJECTIVES: To evaluate the cost-effectiveness of durvalumab in adult patients with locally advanced unresectable non-small cell lung cancer (NSCLC) whose tumours express PD-L1 on at least 1% of tumour cells and whose disease has not progressed after concurrent platinum-based chemoradiation in France.

METHODS: A semi-Markov model adapted to the French setting was used to estimate costs and benefits of durvalumab consolidation versus surveillance on a 10-year time horizon. Parametric functions were fitted to the phase III PACIFIC trial data regarding time to progression (TTP), progression-free survival (PFS) and post-progression survival (PPS). Health state utilities were estimated from the PACIFIC trial using EQ-5D-5L mapped to EQ-5D-3L to apply French preference scores. Costs (2018) were calculated from a wide payer perspective (collective). Resource use for follow-up and for surveillance were based on expert opinion. All grade 3-4 treatment related adverse events (AE) observed in the PACIFIC trial were included with impact on cost and loss of quality of life. Costs and outcomes were discounted at 4%. Sensitivity and scenario analyses were performed.

RESULTS: Compared to surveillance, durvalumab was associated with a gain of 1.40 (4.54 versus 3.14) life years (LYs) and 1.14 (3.57 versus 2.43) quality-adjusted life years (QALYs) and an incremental cost of €60,723 driven by treatment costs and prolonged life expectancy in a context of comparison to a non-active treatment. The incremental cost-effectiveness ratio (ICER) was €43,229/LY and €27,303/LY (-37%) with a 30-year time horizon; the incremental cost-utility ratio (ICUR) was €53,332/QALY and €33,961/QALY (-36%) with a 30-year time horizon. Results of the sensitivity analyses showed great robustness of the model and hypotheses.

CONCLUSIONS: The present evaluation suggest that, with a willingness to pay of €100,000/QALY gained, durvalumab consolidation has a 99.4% cost-effectiveness probability compared to surveillance for treating locally advanced unresectable NSCLC after concurrent platinum-based chemoradiation in adults.