# Cost-Effectiveness of Durvalumab After Chemoradiotherapy in Limited-Stage SCLC

## TL;DR

This study evaluates whether adding durvalumab after chemoradiotherapy for limited-stage small cell lung cancer is cost-effective in Taiwan, finding it is not unless the drug's price is significantly reduced.

## Contribution

The study provides a cost-effectiveness analysis of durvalumab consolidation therapy in limited-stage SCLC from the perspective of the Taiwanese healthcare system.

## Key findings

- Durvalumab consolidation therapy had an ICER of $101,734 per QALY, exceeding the $70,000 threshold.
- Reducing durvalumab's cost to $3,893 per 4 weeks could make it cost-effective.
- The therapy had only a 0.3% probability of being cost-effective at the willingness-to-pay threshold.

## Abstract

In the ADRIATIC trial, durvalumab consolidation therapy improved the overall survival and progression-free survival of patients with limited-stage SCLC responding to chemoradiotherapy. Based on the data, we aim to assess the cost-effectiveness of the therapy from the perspective of the Taiwanese health care sector.

Simulated patients with limited-stage SCLC responding to chemoradiotherapy were entered into a partitioned survival model comparing durvalumab consolidation with no consolidation therapy. The model inputs were derived from the ADRIATIC trial (survival outcomes, adverse events, and subsequent therapies), National Health Insurance payments (costs of physician visits, monitoring, drug administration, and end-of-life care), and the hospital cohort (utility values). A lifetime horizon and annual discount rate of 3% were applied. Subgroup, one-way deterministic, and probabilistic analyses were performed.

Durvalumab consolidation therapy incurred an additional $91,734 USD and brought about 0.90 quality-adjusted life years (QALYs) gained, resulting in an incremental cost-effectiveness ratio (ICER) of $101,734 USD per QALY. The ICER remained higher than the willingness-to-pay threshold of $70,000 USD per QALY across most patient subgroups. The most influential factor for the ICER was the cost of durvalumab. If the 4-week drug cost could be reduced to $3893 USD, the ICER would fall below 70,000 USD per QALY. At the willingness-to-pay threshold, durvalumab consolidation therapy had a probability of 0.3% being cost-effective.

Our analysis suggests that durvalumab consolidation therapy is not cost-effective for patients with limited-stage SCLC. Reducing the price of the therapy enhances cost-effectiveness.