Assessing the Cost-Effectiveness of Necitumumab in Squamous-Cell Lung Cancer

Dana Taylor

August 2015, Vol 6, No 7 - Economics of Cancer Care


Chicago, IL—An economic analysis presented by Daniel Goldstein, MD, of Emory University, Atlanta, GA, at the 2015 American Society of Clinical Oncology meeting, was conducted to see at what price will necitum­umab (which is currently being reviewed by the FDA for use in metastatic squamous-cell lung cancer) be cost-­effective. According to this analysis, necitumumab will have to be priced at less than $1300 per cycle to be cost-­effective based on the accepted willing­ness-to-­pay threshold of $150,000.

“Our study is not only useful for evaluating this drug in this disease, but provides a framework for establishing value-based prices for all new cancer drugs entering the marketplace,” Dr Goldstein said.

The excitement over targeted therapies in lung cancer has not involved tumors of squamous histology. Therefore, the positive results of the SQUIRE trial with necitumumab, an EGFR inhibitor, were therefore considered encouraging. The trial showed an overall survival benefit of 1.6 months in the first-line setting when adding necitumumab to gemcitabine plus cisplatin followed by maintenance with necitumumab compared with the doublet alone.

“The study reached its prespecified end point, so it may soon gain FDA approval and become the standard of care in this population,” Dr Goldstein said. Providing cost-effectiveness information to the FDA could influence the cost at which the drug will launch, he said.

The investigators used incremental cost-effectiveness ratio (ICER) and worked backward to see what necitum­umab actually needed to cost to demonstrate this ICER,” Dr Goldstein explained.

In the base-case analysis, the addition of necitumumab produced an incremental survival benefit of 0.15 life-years and 0.11 quality-adjusted life-years (QALYs). At $350 per cycle, necitumumab meets the $50,000 per QALY willingness-to-pay threshold; however, to stay under the $200,000 willingness-to-pay threshold, the cost of adding necitum­umab to chemotherapy must not exceed $1850 per cycle.

“We established with 90% confidence that when necitumumab costs less than $563 per cycle, the ICER for adding necitumumab would be less than $100,000 per QALY, and at less than $1309, the ICER would be less than $200,000,” Dr Goldstein noted.

They then inputted values that would “put this in line with the cost of drugs being released in 2015” and found that when the cost of necitumumab exceeded $6628 per cycle, there was 99% confidence that the ICER would exceed $500,000 per QALY.

Dr Goldstein concluded, “For necitum­umab to be considered cost-effective, it should cost between $563 and $1300 per cycle, which is equivalent to $750 to $1745 per month.”