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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.
Clin Ther. 2020 05; 42(5):830-847.CT

Abstract

PURPOSE

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.

METHODS

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.

FINDINGS

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.

IMPLICATIONS

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 National Health Service perspective, providing added value in a potentially curative care setting.

Authors+Show Affiliations

Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy. Electronic address: patrizio.armeni@unibocconi.it.Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy.Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy.Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy.Oncology Unit, Policlinico di Milano, Milan, Italy.Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32354495

Citation

Armeni, Patrizio, et al. "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." Clinical Therapeutics, vol. 42, no. 5, 2020, pp. 830-847.
Armeni P, Borsoi L, Fornaro G, et al. 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. Clin Ther. 2020;42(5):830-847.
Armeni, P., Borsoi, L., Fornaro, G., Jommi, C., Grossi, F., & Costa, F. (2020). 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. Clinical Therapeutics, 42(5), 830-847. https://doi.org/10.1016/j.clinthera.2020.03.012
Armeni P, et al. 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. Clin Ther. 2020;42(5):830-847. PubMed PMID: 32354495.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Armeni,Patrizio, AU - Borsoi,Ludovica, AU - Fornaro,Giulia, AU - Jommi,Claudio, AU - Grossi,Francesco, AU - Costa,Francesco, Y1 - 2020/04/27/ PY - 2020/01/07/received PY - 2020/03/15/revised PY - 2020/03/22/accepted PY - 2020/5/2/pubmed PY - 2020/5/2/medline PY - 2020/5/2/entrez KW - cost-effectiveness analysis KW - durvalumab KW - immune-checkpoint inhibitors KW - net monetary benefit analysis KW - non–small cell lung cancer SP - 830 EP - 847 JF - Clinical therapeutics JO - Clin Ther VL - 42 IS - 5 N2 - PURPOSE: 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. METHODS: 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. FINDINGS: 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. IMPLICATIONS: 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 National Health Service perspective, providing added value in a potentially curative care setting. SN - 1879-114X UR - https://www.unboundmedicine.com/medline/citation/32354495/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(20)30177-6 DB - PRIME DP - Unbound Medicine ER -