{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T03:29:58Z","timestamp":1792553398999,"version":"4.5.0"},"reference-count":51,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Standard of care for unresectable locally advanced non\u2013small cell lung cancer (NSCLC) involves definitive chemoradiotherapy followed by maintenance therapy with durvalumab. However, the cost of durvalumab has been cited as a barrier to its use in various health systems.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the cost-effectiveness of durvalumab vs placebo as maintenance therapy in patients with unresectable stage III NSCLC from 4 international payer perspectives (US, Brazil, Singapore, and Spain).<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>In this economic evaluation, a Markov model was designed to compare the lifetime cost-effectiveness of maintenance durvalumab for unresectable stage III NSCLC with that of placebo, using 5-year outcomes data from the PACIFIC randomized placebo-controlled trial. Individual patient data were extracted from the PACIFIC, KEYNOTE-189, ADAURA, ALEX, and REVEL randomized clinical trials to develop a decision-analytic model to determine the cost-effectiveness of durvalumab compared with placebo maintenance therapy over a 10-year time horizon. Direct costs, adverse events, and patient characteristics were based on country-specific payer perspectives and demographic characteristics. The study was conducted from June 1, 2022, through December 27, 2023.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Life-years, quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs) were estimated at country-specific willingness-to-pay thresholds ([data reported in US$] US: $150\u202f000 per QALY; Brazil: $22\u202f251 per QALY; Singapore: $55\u202f288 per QALY, and Spain: $107\u202f069 per QALY). One-way and probabilistic sensitivity analyses were performed to account for parameters of uncertainty. A cost-threshold analysis was also performed.<\/jats:p><\/jats:sec>Results<\/jats:title>The US base-case model found that treatment with durvalumab was associated with an increased cost of $114\u202f394 and improved effectiveness of 0.50 QALYs compared with placebo, leading to an ICER of $228\u202f788 per QALY. Incremental cost-effectiveness ratios, according to base-case models, were $141\u202f146 for Brazil, $153\u202f461 for Singapore, and $125\u202f193 for Spain. Durvalumab price adjustments to the PACIFIC data improved cost-effectiveness in Singapore, with an ICER of $45\u202f164. The model was most sensitive to the utility of durvalumab.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cost-effectiveness analysis of durvalumab as maintenance therapy for unresectable stage III NSCLC, the therapy was found to be cost-prohibitive from the perspective of various international payers according to country-specific willingness-to-pay thresholds per QALY. The findings of the study suggest that discounted durvalumab acquisition costs, as possible in Singapore, might improve cost-effectiveness globally.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.13938","type":"journal-article","created":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T15:35:00Z","timestamp":1717083300000},"page":"e2413938","source":"Crossref","is-referenced-by-count":16,"title":["International Cost-Effectiveness Analysis of Durvalumab in Stage III Non\u2013Small Cell Lung Cancer"],"prefix":"10.1001","volume":"7","author":[{"given":"Samuel A.","family":"Kareff","sequence":"first","affiliation":[{"name":"University of Miami Sylvester Comprehensive Cancer Center\/Jackson Memorial Hospital, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunwoo","family":"Han","sequence":"additional","affiliation":[{"name":"University of Miami Miller School of Medicine, Miami, 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