OBJECTIVES: To model the cost-effectiveness of second-line lurbinectedin treatment in adults with metastatic SCLC with disease progression on or after platinum-based chemotherapy in the US.

METHODS: A lifetime partitioned-survival model was developed from a US-payer perspective. The efficacy and safety of lurbinectedin was derived from clinical trial data. In the overall population, the comparator was a mix of other treatment options used in SCLC from an external-control-arm (ECA) analysis and simulated using proportional hazard models. Based on a published network meta-analysis, a subgroup analysis in platinum-sensitive patients (chemotherapy-free interval ≥90 days) that compared lurbinectedin against platinum rechallenge (PR) and topotecan (intravenous [TOP-IV] and oral [TOP-oral]) was conducted. Healthcare resource use included second-line and subsequent treatment acquisition and administration costs, serious adverse events management, prophylaxis (granulocyte colony-stimulating factor [G-CSF]), office visits, monitoring, and mortality cost. Prophylactic treatment schedule (G-CSF), office visits, and monitoring followed the latest NCCN guidelines. Costs and health outcomes were discounted at 3%.

RESULTS: Overall, the higher acquisition cost of lurbinectedin ($39,440 and $33,920 for lurbinectedin and the ECA, respectively) was partially offset by prophylaxis cost ($1,875 and $3,132 for lurbinectedin and the ECA, respectively). Lurbinectedin-treated patients also had higher life years ([LYs] 1.16 vs 0.82) and quality-adjusted life years ([QALYs] 0.80 vs 0.58) than patients in the ECA. The incremental cost-effectiveness ratio (ICER) was $20,691/QALY. In the platinum-sensitive subgroup, lurbinectedin-treated patients incurred lower myelosuppression prophylaxis and adverse event costs than those with TOP-IV/oral. The ICER for lurbinectedin vs PR, TOP-IV, and TOP-oral was $63,017/QALY, $53,835/QALY, and $22,999/QALY, respectively. Probabilistic sensitivity analysis showed the base case conclusions were consistent across a range of real-world values.

CONCLUSIONS: Lurbinectedin is a cost-effective second-line treatment for patients with metastatic SCLC with disease progression on or after platinum-based chemotherapy and is under the willingness-to-pay thresholds of $100,000/QALY.