{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T14:04:00Z","timestamp":1773410640495,"version":"3.50.1"},"reference-count":43,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"11","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Glob Oncol"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Small cell lung cancer (SCLC) is an aggressive neuroendocrine malignancy characterized by poor prognosis. The ADRIATIC trial demonstrated significant survival benefits with durvalumab as maintenance therapy for limited-stage SCLC (LS-SCLC). However, the high cost of durvalumab necessitates an evaluation of its cost-effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A partitioned survival model was developed to assess the cost-effectiveness of durvalumab consolidation therapy compared with the standard of care (SOC). The model comprised three mutually exclusive health states: progression-free survival (PFS), progression of disease (POD)\/metastasis, and death. Incremental cost-effectiveness ratio (ICER) was calculated as cost per quality-adjusted life year (QALY) gained, with a willingness-to-pay (WTP) threshold of $150,000 in US dollars (USD)\/QALY. One-way and probabilistic sensitivity analyses were conducted. Analysis for POD was also stratified into intrathoracic, extrathoracic, and CNS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Durvalumab improved overall survival (OS) to 66.1 months and PFS to 40.2 months, compared with 57.8 and 31.8 months for SOC, respectively. The total cost of durvalumab was $163,722 USD versus $25,816 USD for placebo, resulting in an incremental cost of $137,905 USD. Durvalumab provided an incremental QALY gain of 0.36 years, yielding an ICER of $383,069 USD\/QALY, exceeding WTP. On stratification, durvalumab in patients with extrathoracic progression nearly met WTP (ICER, $151,137 USD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Durvalumab remains cost-prohibitive for the overall cohort, exceeding acceptable thresholds despite favorable outcomes. Subgroup analysis, however, indicates that selective use in patients with extrathoracic progression may enhance cost-effectiveness. Overcoming economic barriers will be essential for the sustainable integration of immunotherapy into routine care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/go-25-00225","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T20:58:13Z","timestamp":1766177893000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":1,"title":["Cost-Effectiveness Analysis of Durvalumab in Limited-Stage Small Cell Lung Cancer in the United States"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6917-5568","authenticated-orcid":true,"given":"Chinmay T.","family":"Jani","sequence":"first","affiliation":[{"name":"Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aysswarya","family":"Manoharan","sequence":"additional","affiliation":[{"name":"Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunwoo","family":"Han","sequence":"additional","affiliation":[{"name":"Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0508-6075","authenticated-orcid":true,"given":"Xena","family":"Zheng","sequence":"additional","affiliation":[{"name":"Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2724-1432","authenticated-orcid":true,"given":"Subul","family":"Malik","sequence":"additional","affiliation":[{"name":"Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9031-2256","authenticated-orcid":true,"given":"Dan","family":"Morgenstern-Kaplan","sequence":"additional","affiliation":[{"name":"Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5617-5609","authenticated-orcid":true,"given":"Ana S.","family":"Salazar","sequence":"additional","affiliation":[{"name":"Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7431-1221","authenticated-orcid":true,"given":"Samuel","family":"Kareff","sequence":"additional","affiliation":[{"name":"Lynn Cancer Institute, Baptist Health, Boca Raton, FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1151-9903","authenticated-orcid":true,"given":"Gilberto","family":"Lopes","sequence":"additional","affiliation":[{"name":"Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"233","reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.01435"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32222-6"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2404873"},{"key":"e_1_3_7_5_2","unstructured":"U.S. Food and Drug Administration: FDA approves durvalumab for limited-stage small cell lung cancer. https:\/\/www.fda.gov\/drugs\/resources-information-approved-drugs\/fda-approves-durvalumab-limited-stage-small-cell-lung-cancer"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2020.7796"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.13938"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X16670617"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2018.08.018"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/CM9.0000000000000536"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-12-9"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000985"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1248867"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.33761"},{"key":"e_1_3_7_15_2","doi-asserted-by":"crossref","unstructured":"Wolchok JDC-SV Gonzalez R et al: Efficacy and safety results from a phase III trial of nivolumab alone or combined with ipilimumab versus ipilimumab alone in treatment-naive patients with advanced melanoma. 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