The Economic Value of Multilineage Myeloprotection with Trilaciclib in Extensive-Stage Small Cell Lung Cancer: Alternate Cost-Effectiveness Metrics of Averting the Harms of Cytopenias

Abstract

Objectives. The first-in-class CDK4/6-inhibitor trilaciclib provides multilineage protection against myelotoxic chemotherapy to reduce the incidence of cytopenias and avoid disturbances to the treatment regimen. We aimed to specify and apply 5 alternate metrics of the value of trilaciclib as to harms averted, including 2 focused on single or multilineage cytopenias averted (model 1) and 3 focused on chemotherapy disturbances averted (model 2) in the setting of extensive-stage small cell lung cancer (ES SCLC).Methods. Model 1 metrics included the Differential Cost-to-Cytopenia Ratio (metric 1) and the Differential Cytopenia-Cost-to-Cytopenia Ratio (metric 2) and were applied to pooled trial data of first-line treatment. Model 2 metrics comprised the Differential Cost-to-Chemotherapy-Disturbances Ratio (metric 3), Differential Cost-to-Chemotherapy-Delays Ratio (metric 4), and Differential Cost-to-Chemotherapy-Dose-Reductions Ratio (metric 5) and were applied to data from one first-line trial. Analyses were from the US payer perspective over a time-horizon of four 21-day cycles; probabilistic sensitivity analyses (PSA) with 1,000 simulations were performed. All estimates are in 2022 USD rounded to the dollar. Results. Metric 1 revealed per-patient savings of $471 (PSA $266) per single or multilineage cytopenia averted with trilaciclib. Metric 2 showed that averting one cytopenia yield per-patient savings of $2,508 ($2,451) in overall cytopenia management costs. Metric 3 estimated an additional cost of $16,251 ($15,975) to avert a chemotherapy disturbance, whether delay or dose reduction; and additional costs of $29,720 ($29,370) to avert one chemotherapy delay (metric 4) and $35,857 ($35,117) to avert one chemotherapy dose reduction. Cost-effectiveness planes consistently showed favorable results in cytopenias and chemotherapy regimens averted. Conclusions. With trilaciclib aiming to reduce the incidence and consequences of cytopenias cost-effectiveness metrics should reflect the harms averted. The reduction in cytopenias with trilaciclib yields net cost-savings. The incremental costs of trilaciclib therapy to avoid disturbances to the chemotherapy regimen are deemed reasonable and equitable.