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Published on: February 17, 2022
Cost-Effectiveness of Tarlatamab in the Second-Line Treatment of Refractory Small Cell Lung Cancer From a US
Hanrui Zheng1,2, Feng Wen3,4, Bin Wu1,2
1Department of Clinical Pharmacy, West China Hospital, Sichuan University, Chengdu, China.
Background:
Compared with chemotherapy, tarlatamab significantly prolonged overall survival in patients with extensive-stage small cell lung cancer (ES-SCLC) whose disease progressed during or after platinum-based chemotherapy. The aim of this study was to evaluate the cost-effectiveness of tarlatamab versus chemotherapy as a second-line treatment for ES-SCLC from the perspective of the US health care system.
Methods:
A partitioned survival model was constructed to simulate disease progression on the basis of the DeLLphi-304 trial results. A 28-day cycle length and a 10-year time horizon were adopted for the model. Direct medical costs and health utility estimates were extracted from previously published studies and publicly available databases. The model outputs included the total and incremental costs and quality-adjusted life years (QALYs). The primary outcome was the incremental cost-effectiveness ratio (ICER). The willingness-to-pay (WTP) thresholds were set at $150 000/QALY and $200 000/QALY for the United States. One-way sensitivity analysis and probabilistic sensitivity analyses were performed to evaluate the robustness of the model outcomes.
Results:
At an incremental cost of $203 332.28, tarlatamab yielded an additional 0.29 QALYs compared with chemotherapy. This resulted in an ICER of $701 145.79/QALY, which substantially exceeded the WTP thresholds. The cost of tarlatamab emerged as a major influential parameter in the sensitivity analyses, demonstrating its substantial impact on cost-effectiveness outcomes. Sensitivity and scenario analyses confirmed the robustness of the cost-effectiveness results.
Conclusion:
At WTP thresholds of $150 000/QALY and $200 000/QALY, tarlatamab was not considered a cost-effective option at the current price compared with chemotherapy for the treatment of recurrent ESCLC from the US payer perspective.
