US cost-effectiveness analysis showed durvalumab in limited-stage small cell lung cancer improved survival but exceeded thresholds.
Durvalumab Cost-Effectiveness in LS-SCLC
Limited-stage small cell lung cancer (LS-SCLC) remains an aggressive malignancy with high relapse risk, even after initial response to concurrent chemoradiotherapy. Following the ADRIATIC trial, durvalumab has been evaluated as maintenance therapy for LS-SCLC, raising important questions about real-world value given its high acquisition cost.
In a US-based cost-effectiveness analysis, investigators compared durvalumab consolidation therapy with standard of care using a partitioned survival model designed to reflect clinically meaningful outcomes. The model considered three mutually exclusive health states: progression-free survival, progression of disease or metastasis, and death. Outcomes were summarized as quality-adjusted life years (QALYs), with cost-effectiveness assessed using a willingness-to-pay threshold of $150,000 per QALY gained.
Survival Gains, But Value Thresholds Not Met
Durvalumab was associated with longer survival outcomes in the modeled cohort. Overall survival increased to 66.1 months with durvalumab versus 57.8 months with standard of care, while progression-free survival improved to 40.2 months versus 31.8 months, respectively.
These gains came with substantially higher costs. Total durvalumab costs were estimated at $163,722 compared with $25,816 for placebo, producing an incremental cost of $137,905. The incremental QALY gain was 0.36 years, resulting in an incremental cost-effectiveness ratio (ICER) of $383,069 per QALY, which exceeded the predefined US threshold.
Subgroup Signals in Extrathoracic Progression
When progression of disease was stratified by location, durvalumab approached cost-effectiveness in patients with extrathoracic progression, with an ICER of $151,137 per QALY. The authors noted that more selective use may improve durvalumab cost-effectiveness in LS-SCLC, highlighting the need to address economic barriers alongside clinical benefit. This analysis highlights the growing importance of pairing survival benefits with sustainable treatment costs in oncology.
Reference: Jani CT 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.
