Comparative Cost-Effectiveness of Atezolizumab Versus Durvalumabas First-Line Combination Treatment with Chemotherapy for Patients with Extensive-Disease Small-Cell Lung Cancer in Japan

Sep 22, 2026

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Recent trials indicate that immune checkpoint inhibitors (ICIs), atezolizumab and durvalumab, combined with chemotherapy, improve outcomes for extensive-disease small-cell lung cancer (ED-SCLC). Because ICIs are costly, this study evaluates the cost-effectiveness of ICI regimens using carboplatin plus etoposide (CE) as first-line therapy in Japan. IMpower 133 and CASPIAN were used within a partitioned survival model to estimate medical costs and quality-adjusted life years (QALYs), using a 20-year horizon, 2% discounting, and a 15 million JPY per QALY threshold. Uncertainty was tested using Monte Carlo simulation, scenario analysis, and one-way sensitivity analyses.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background and Objective

Methods

Modeling approach and parameters

Sensitivity analyses

Results

Conclusion

Introduction

Clinical Drug Investigation (2024) 44:749–759 [https://doi.org/10.1007/s40261-024-01383-x](https://doi.org/10.1007/s40261-024-01383-x) Comparative Cost‑Effectiveness of Atezolizumab Versus Durvalumabas First‑Line Combination Treatment with Chemotherapy for Patients with Extensive‑Disease Small‑Cell Lung Cancer in Japan Munenobu Kashiwa1,2 · MihoTsukada3 · Ryo Matsushita1 Accepted: 16 July 2024 / Published online: 21 September 2024 © The Author(s) 2024 Abstract Background and Objective Recent trials have shown that immune checkpoint inhibitors (ICIs), atezolizumab and durvalumab, in combination with chemotherapy, are effective in treating extensive-disease small-cell lung cancer (ED-SCLC) . However, owing to the expensiveness of ICIs, monetary issues arise. The cost-effectiveness of ICI combination treatment with carboplatin plus etoposide (CE) as first-line therapy for patients with ED-SCLC was examined to aid public health policy in Japan. Methods IMpower 133 and CASPIAN data were used to create a partitioned survival model. Medical expenses and qualityadjusted life years (QALYs) were considered. The analysis period, discount rate, and threshold were set at 20 years, 2%, and 15 million Japanese yen (JPY) [114,068 US dollars (USD)] per QALY, respectively. The incremental cost-effectiveness ratio (ICER) was calculated by gathering reasonable parameters from published reports and combining the costs and effects using parametric models. Monte Carlo simulations, scenario analysis, and one-way sensitivity analyses were employed to quantify uncertainty. Results After comparing atezolizumab plus CE (ACE) and durvalumab plus CE (DCE) with CE, it was found that the ICERs exceeded the threshold at 35,048,299 JPY (266,527 USD) and 36,665,583 JPY (278,826 USD) per QALY, respectively. For one-way sensitivity and scenario assessments, the ICERs exceeded the threshold, even with considerably adjusted parameters. For the probabilistic sensitivity analyses, there was no probability that the ICER of the ICI combination treatment with chemotherapy would fall below the threshold. Conclusion ACE and DCE were not cost-effective compared with CE as first-line therapy for ED-SCLC in Japan. Both these therapies exhibited high ICERs. 1 Introduction Lung cancer is the world’s deadliest cancer, with 1.8 million deaths in 2020, accounting for 18.0%(14.3% and 13.7% for men and women, respectively) of all cancer * Munenobu Kashiwa [munenobuk@p.kanazawa-u.ac.jp](munenobuk@p.kanazawa-u.ac.jp) 1 Department of Clinical Pharmacy and Healthcare Science, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa 920-1192, Japan 2 Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University, Kyoto city, Kyoto, Japan 3 Department of Clinical Pharmacy and Healthcare Science, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan deaths [1] . This is the highest cancer mortality rate for men and the second highest for women [1] . In 2020, the total number of fatalities caused by lung cancer in Japan was estimated to exceed 75,000, amounting to 19.9% of all cancer-related deaths [2] . Lung cancer is the primary cause of death among men and the second most common cause of death among women, after colorectal cancer [2] . Small-cell lung cancer (SCLC) is a specific kind of lung cancer, representing approximately 10–15% of all lung cancer cases [3] . It exhibits early and extensive metastasis, resulting in an exceedingly unfavorable prognosis [4] . Limited-disease SCLC (LD-SCLC) is defined by several clinical trials as “lesions confined to the same side of the chest as the tumor [5] . It involves the lymph nodes on the opposite side of the chest and above the collarbone, without cancerous fluid in the heart or the sac surrounding the hea

FAQs

Which treatments were compared for first-line ED-SCLC in the cost-effectiveness analysis?

The study compared atezolizumab plus carboplatin plus etoposide (ACE) and durvalumab plus carboplatin plus etoposide (DCE) against carboplatin plus etoposide (CE) alone as first-line therapy.

How were costs and health outcomes (QALYs) estimated?

IMpower 133 and CASPIAN data were used to build a partitioned survival model, incorporating medical expenses and quality-adjusted life years (QALYs).

What was the main finding regarding cost-effectiveness in Japan?

ACE and DCE were not cost-effective versus CE in Japan as first-line treatment, with ICERs exceeding the 15 million JPY per QALY threshold in base and adjusted analyses, and no probabilistic chance of falling below the threshold.

Sep 22, 2026

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