Evaluating the Cost-Effectiveness of Immunotherapy in Lung Cancers

Among the many facets of cancer care, the cost-effectiveness of treatment is ever present in the minds of patients. As most treatments carry high costs, not counting the loss-of-work also associated with the high toxicity of treatment, there is much to consider when providing care to patients. Samuel A. Kareff, MD, MPH, a medical oncologist and hematologist at Lynn Cancer Institute of Baptist Health South Florida, spoke with CancerNetwork® about this very topic.

The discussion happened following the publication of 2 studies about the cost-effectiveness of durvalumab (Imfinzi) in patients with stage III non–small cell lung cancer (NSCLC) and limited-stage small cell lung cancer (SCLC).^1,2 Both studies sought to answer at what levels were the treatments considered “useful and beneficial” to patients as a whole. Ultimately, both studies found that, overall, durvalumab was cost-prohibitive despite the favorable treatment outcomes it produced.

Investigators assessed this question both domestically, in the US, but also globally, in Singapore, Brazil, and Spain. Kareff highlighted that in Singapore specifically, while the cost of immunotherapy was higher than the willingness-to-pay threshold, there were methods to diminish that difference. One of those methods included discounted rug pricing, which was attained through accelerated access approvals.

This finding underscores the reality that payers and private manufactures can collaborate to promote access to expensive treatments, ensuring that all patients get the best treatment for their disease at the optimal time.

Transcript:

With my former colleagues during my training in hematology-oncology, we recently embarked on a series of cost effectiveness analyzes, looking at the benefits of using maintenance immunotherapy for 2 separate but related disease entities, namely [NSCLC and SCLC]. [We looked at] how that translated to both the patient in terms of those outputs mentioned, but also to the healthcare system. We had looked in both the domestic context within the US, but also internationally for our colleagues…in Singapore, Brazil, and Spain as well. What we found is that when we use these traditional, what we call, willingness-to-pay thresholds, meaning…from the payer perspective, especially in public-funded systems, at what levels these therapies are often thought to be useful and beneficial to patients at large. Where are these immunotherapies falling?

It’s interesting, because in our international analysis, we found that, for the majority of the context we looked at, the immunotherapies may be priced slightly higher than the traditional willingness-to-pay threshold that's cited in the literature, but uniquely in a Singaporean context, we saw that with some accelerated access approvals, namely discounted drug pricing, we can actually meet these willingness-to-pay thresholds such that they benefit both patients individually but also society at large. This just shows that payers can work with private manufacturers of drugs to enable access at a global level and make sure that all patients are getting the best drug at the right time for their disease course.

Reference

1. Kareff SA, Han S, Haaland B, et al. International cost-effectiveness analysis of durvalumab in stage III non-small cell lung cancer. JAMA Netw Open. 2024;7(5):e2413938. doi:10.1001/jamanetworkopen.2024.13938
2. Jani CT, Manoharan A, Han S, et al. Cost-effectiveness analysis of durvalumab in limited-stage small cell lung cancer in the United States. JCO Glob Oncol. 2025;11:e2500225. doi:10.1200/GO-25-00225