OBJECTIVES: This study aimed to quantify costs of managing grade 3+ treatment-emergent adverse events (TEAEs) associated with datopotamab deruxtecan (Dato-DXd), docetaxel monotherapy (Doce), and docetaxel-containing regimens in patients with advanced or metastatic nonsquamous non-small cell lung cancer (NSCLC) whose cancer has progressed following prior treatment, from a France, Italy, Spain, UK, and USA healthcare system perspective.

METHODS: Incidences of TEAEs were extracted from TROPION-Lung01 data, and publications of LUME-Lung01 (nintedanib plus docetaxel [NIN+Doce]) and REVEL (ramucirumab plus docetaxel [RAM+Doce]), restricting to TEAEs occurring as any-grade in ≥10% of patients in any treatment arm. Doce data were retrieved from all three trials. All patients were assumed to be treated in hospital. TEAE management costs were estimated using Disease-Related Groups (DRG) codes. DRGs for highly incident TEAEs were validated by clinical experts in the USA and France. To validate the costing analysis, a complementary Bayesian network meta-analysis (NMA) was conducted to obtain odds ratios (ORs) of having grade 3+ TEAEs.

RESULTS: Total grade 3+ TEAE incidence was lowest for Dato-DXd (40.9%), followed by Doce (55.7-71.8%), NIN+Doce (75.9%), and RAM+Doce (78.9%). Dato-DXd incurred the lowest estimated costs. Compared to Dato-DXd, costs in the five countries were 1.39 to 5.32 times higher for Doce, 2.98 to 5.06 times higher for NIN+Doce, and 2.91 to 7.15 times higher for RAM+Doce. Total costs per treatment were lowest in Spain and France, and highest in the USA. NMA results were consistent, with ORs favouring Dato-DXd.

CONCLUSIONS: In previously treated nonsquamous NSCLC, Grade 3+ TEAEs of docetaxel-containing regimens incur significant inpatient costs to healthcare systems across Europe and the USA. In addition to the clinically meaningful benefit observed for Dato-DXd versus docetaxel monotherapy, Dato-DXd has a more manageable and tolerable safety profile and therefore offers reduced toxicity and reduced economic burden for patients and healthcare systems respectively.