Cost-effectiveness and Net Monetary Benefit of Durvalumab Consolidation Therapy Versus No Consolidation Therapy After Chemoradiotherapy in Stage III Non–small Cell Lung Cancer in the Italian National Health Service

• Published in: Clinical therapeutics 2020-05, Vol.42 (5), p.830-847
• Main Authors: Armeni, Patrizio, Borsoi, Ludovica, Fornaro, Giulia, Jommi, Claudio, Grossi, Francesco, Costa, Francesco
• Format: Article
• Language: English
• Subjects: Antibodies, Monoclonal - economics; Antibodies, Monoclonal - therapeutic use; Antineoplastic Agents, Immunological - economics; Antineoplastic Agents, Immunological - therapeutic use; Apoptosis; Cancer therapies; Carcinoma, Non-Small-Cell Lung - economics; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - therapy; Cell death; Chemoradiotherapy; Chemotherapy; Clinical medicine; Clinical trials; Consolidation; Consolidation Chemotherapy; Cost analysis; Cost benefit analysis; cost-effectiveness analysis; Decision trees; durvalumab; Female; Health services; Humans; immune-checkpoint inhibitors; Immunotherapy; Italy; Lung cancer; Lung Neoplasms - economics; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Male; Markov chains; Metastasis; Middle Aged; Monoclonal antibodies; Neoplasm Staging; net monetary benefit analysis; Non-small cell lung carcinoma; non–small cell lung cancer; Patients; PD-1 protein; Quality-Adjusted Life Years; Radiation therapy; Randomized Controlled Trials as Topic; Sensitivity analysis; State Medicine; Survival; Survival Analysis; Targeted cancer therapy; Therapy
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2020.03.012

The aim of this study was to evaluate the cost-effectiveness and net monetary benefit of durvalumab consolidation therapy compared with no consolidation therapy after chemoradiotherapy in patients with stage III non–small cell lung cancer with programmed cell death 1 ligand 1 expression ≥1% from the Italian National Health Service perspective. We developed a 12-month decision tree combined with a lifetime cohort Markov model in which patients were assigned to receive durvalumab consolidation therapy or active follow-up (Italian standard of care) after chemoradiotherapy to compare cost-effectiveness and net monetary benefit of the two strategies during a 40-year period. Clinical outcomes data were obtained from the respective clinical trials and extrapolated using survival analysis; cost data were derived from Italian official sources and relevant real-world studies. The incremental cost-effectiveness ratio, incremental cost-utility ratio, and incremental net monetary benefit were computed and compared against a 16,372 € per quality-adjusted life-year (QALY) willingness-to-pay threshold. We performed deterministic sensitivity analysis and probabilistic sensitivity analysis to assess how uncertainty affected results; we also performed scenario analyses to compare results under different pricing settings. In the base-case scenario, during a 40-year period, the total costs for patients treated with durvalumab consolidation therapy and active follow-up were €59,860 and €49,840 respectively; life-years gained were 3.47 and 3.31, respectively; and QALYs gained were 2.73 and 2.50, respectively, with an incremental cost-effectiveness ratio of €62,131 per life-year, an incremental cost-utility ratio of €42,322 per QALY, and an incremental net monetary benefit of €−6,144. We found that durvalumab was cost-effective (incremental net monetary benefit = 0) when a discount of 13% and 30% on its official price was applied, considering all other drugs priced according to official or maximum selling prices, respectively. Results were most sensitive to the progression-free survival rate for durvalumab and active follow-up, health utility in progression-free state, and price of subsequent treatments. Our analysis indicates that durvalumab consolidation is cost-effective when a discount is applied on its official price. These results suggest that durvalumab may deliver an incremental health benefit with a contained upfront cost during a 40-year period, from the Italian Nationa