Cost-effectiveness of tumor-treating fields plus standard therapy for advanced non-small cell lung cancer progressed after platinum-based therapy in the United States

Wentao Tian; Jiaoyang Ning; Liu Chen; Yu Zeng; Yin Shi; Gang Xiao; Shuangshuang He; Guilong Tanzhu; Rongrong Zhou

doi:10.3389/fphar.2024.1333128

Cost-effectiveness of tumor-treating fields plus standard therapy for advanced non-small cell lung cancer progressed after platinum-based therapy in the United States

Front Pharmacol. 2024 Feb 5:15:1333128. doi: 10.3389/fphar.2024.1333128. eCollection 2024.

Authors

Wentao Tian^#¹, Jiaoyang Ning^#¹, Liu Chen¹, Yu Zeng², Yin Shi³, Gang Xiao¹, Shuangshuang He⁴, Guilong Tanzhu¹, Rongrong Zhou^{1

5

6}

Affiliations

¹ Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.
² Changsha Stomatological Hospital, Hunan University of Traditional Chinese Medicine, Changsha, China.
³ Department of Pharmacy, Xiangya Hospital, Changsha, China.
⁴ Department of Radiation Oncology and Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
⁵ Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha, China.
⁶ National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.

^# Contributed equally.

Abstract

Background: Tumor treating fields (TTF) was first approved for treatment of glioblastoma. Recently, the LUNAR study demonstrated that TTF + standard therapy (ST) extended survival in patients with advanced non-small cell lung cancer (NSCLC). This primary objective of this study is to analyze the cost-effectiveness of this treatment from the United States healthcare payers' perspective. Methods: A 3-health-state Markov model was established to compare the cost-effectiveness of TTF + ST and that of ST alone. Clinical data were extracted from the LUNAR study, supplemented by additional cost and utility data obtained from publications or online sources. One-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analysis were conducted. The willingness-to-pay (WTP) threshold per quality-adjusted life-years (QALYs) gained was set to $150,000. The main results include total costs, QALYs, incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (INMB). Subgroup analyses were conducted for two types of ST, including immune checkpoint inhibitor, and docetaxel. Results: During a 10-year time horizon, the costs of TTF + ST and ST alone were $431,207.0 and $128,125.9, and the QALYs were 1.809 and 1.124, respectively. The ICER of TTF + ST compared to ST was $442,732.7 per QALY, and the INMB was -$200,395.7 at the WTP threshold. The cost of TTF per month was the most influential factor in cost-effectiveness, and TTF + ST had a 0% probability of being cost-effective at the WTP threshold compared with ST alone. Conclusion: TTF + ST is not a cost-effective treatment for advanced NSCLC patients who progressed after platinum-based therapy from the perspective of the United States healthcare payers.

Keywords: advanced non-small cell lung cancer; chemotherapy; cost-effectiveness; immunotherapy; tumor treating fields.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National Multidisciplinary Cooperative Diagnosis and Treatment Capacity (lung cancer z027002), National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University (No. 2022LNJJ10), Advanced Lung Cancer Targeted Therapy Research Foundation of China (CTONG-YC20210303), and Chen Xiao-Ping Foundation for the Development of Science and Technology of Hubei Province (CXPJJH121005-01).