BACKGROUND Consolidation immunotherapy with the programmed death ligand 1 (PD-L1) inhibitor durvalumab improves survival in patients with stage III non-small-cell lung cancer responding to radiochemotherapy. The aim of this study was to assess the cost-effectiveness of durvalumab in Switzerland based on the most recent PACIFIC survival follow-up. MATERIALS AND METHODS We constructed a Markov model based on the 3-year follow-up data of the PACIFIC trial and compared consolidation durvalumab with observation. We used published utility values and assessed costs for treatment strategies from the perspective of the Swiss health care payers. Cost-effectiveness was tested both in the intention-to-treat population of the PACIFIC trial unselected for PD-L1 tumor expression and in patients with PD-L1-expressing tumors (≥1%). RESULTS In the unselected/PD-L1-positive patients, durvalumab showed an incremental effectiveness of 0.76/1.18 quality-adjusted life year (QALY) and incremental costs of Swiss Francs (CHF) 67 239/78 177, resulting in incremental cost-effectiveness ratios of CHF 88 703/66 131 per QALY gained, respectively. The most influential factors for the incremental cost-effectiveness ratio were the utility before first progression, costs for durvalumab, and the hazard ratio for overall survival under durvalumab versus observation. The cost-effectiveness of durvalumab was better than CHF 100 000 per QALY gained in 75% of the simulations in probabilistic sensitivity analysis. CONCLUSION Assuming a willingness-to-pay threshold of CHF 100 000 per QALY gained, consolidation durvalumab is likely to be cost-effective both in patients with inoperable stage III non-small-cell lung cancer (NSCLC) unselected for PD-L1 status and in patients with PD-L1-expressing tumors in Switzerland.

中文翻译：

---

在瑞士，对最终放射化学疗法进行III期NSCLC的durvalumab巩固免疫疗法的成本效益分析。

背景技术使用程序性死亡配体1（PD-L1）抑制剂durvalumab的合并免疫疗法可改善对放射化学疗法有反应的III期非小细胞肺癌患者的生存率。这项研究的目的是根据最新的PACIFIC生存随访评估durvalumab在瑞士的成本效益。材料和方法我们根据PACIFIC试验的3年随访数据构建了一个马尔可夫模型，并将合并durvalumab与观察结果进行了比较。我们从瑞士卫生保健支付者的角度，使用已公布的效用价值和评估的治疗策略成本。在未选择PD-L1肿瘤表达的PACIFIC试验的意向治疗人群和表达PD-L1肿瘤的患者（≥1％）中均测试了成本-效果。结果在未选出的/ PD-L1阳性患者中，durvalumab显示出0.76 / 1.18质量调整生命年（QALY）的增量有效性和瑞士法郎（CHF）67 239/78 177的增量成本，从而导致成本效益增加每个QALY所占的比例分别为88703/66 131瑞士法郎。影响成本效益比增加的最有影响的因素是首次进展之前的效用，durvalumab的成本以及durvalumab与观察相比的总生存风险比。在概率敏感性分析中，有75％的模拟结果表明，durvalumab的成本/效果优于每QALY 100000瑞士法郎。结论假设每个QALY获得的支付意愿门槛为10万瑞士法郎，