Table_2_First-Line Durvalumab Plus Platinum-Etoposide Versus Platinum-Etoposide for Extensive-Stage Small-Cell Lung Cancer: A Cost-Effectiveness Analysis.docx

BackgroundThe aim of the present study was to evaluate the cost-effectiveness of durvalumab plus platinum–etoposide versus platinum–etoposide as first-line treatments for small-cell lung cancer from the perspective of the US payer.
MethodsThis study established a partition survival model for three health states, metastasis probability, and safety data based on the CASPIAN clinical trial. The health utility value was mainly derived from the published literature. Only direct medical costs were considered. Sensitivity analyses were conducted to assess the robustness of the incremental cost per quality-adjusted life year (QALY).
ResultsDurvalumab plus platinum–etoposide increased QALY by 0.220 compared to that observed with platinum–etoposide only. The cost increased by $78,198.75 and the incremental cost per QALY increased by $355,448.86. One-way and probability sensitivity analyses indicated that the model parameters varied within a limited range and had no significant effect on the results.
ConclusionsAlthough durvalumab plus platinum–etoposide can improve quality of life, it also substantially increases the cost of medical treatment. Under a willingness-to-pay threshold of $100,000, durvalumab does not have a cost-effective comparative advantage.

背景：本研究旨在从美国支付方视角，评估度伐利尤单抗（durvalumab）联合铂类-依托泊苷与单纯铂类-依托泊苷作为小细胞肺癌一线治疗方案的成本效益。
方法：本研究基于CASPIAN临床试验，构建了涵盖三种健康状态、转移概率及安全性数据的分区生存模型（partition survival model）。健康效用值主要来源于已发表文献，仅考量直接医疗成本。通过敏感性分析评估每质量调整生命年（quality-adjusted life year, QALY）增量成本的稳健性。
结果：相较于单纯铂类-依托泊苷方案，度伐利尤单抗联合铂类-依托泊苷可使QALY提升0.220。其治疗成本增加78,198.75美元，每QALY增量成本升至355,448.86美元。单因素敏感性分析与概率敏感性分析结果显示，模型参数仅在有限范围内波动，未对研究结论产生显著影响。
结论：尽管度伐利尤单抗联合铂类-依托泊苷可改善患者生存质量，但同时也大幅推高了医疗成本。在100,000美元的意愿支付阈值下，度伐利尤单抗方案并不具备成本效益比较优势。