Cost-effectiveness analysis of tarlatamab as second-line therapy for small-cell lung cancer after platinum-based chemotherapy

BACKGROUND: The DeLLphi‑304 trial demonstrated that tarlatamab provides superior efficacy compared with chemotherapy in patients with relapsed small-cell lung cancer (SCLC) after first‑line platinum‑based chemotherapy. Our study aimed to evaluate the cost‑effectiveness of tarlatamab as a second‑line treatment for SCLC from the US healthcare payer perspective. METHODS: We developed a three-state partitioned survival model to estimate costs, life‑years (LYs), quality‑adjusted life‑years (QALYs), and the incremental cost‑effectiveness ratio (ICER). Clinical efficacy was obtained from the DeLLphi‑304 trial. Costs and utilities were derived from the Centers for Medicare & Medicaid Services data and published literature. Sensitivity, scenario, and subgroup analyses assessed model uncertainty and heterogeneity. RESULTS: Compared with chemotherapy, tarlatamab was associated with an ICER of $1,145,233.86/QALY, which substantially exceeded the willingness‑to‑pay (WTP) threshold of $150,000/QALY. The model was most sensitive to the cost of tarlatamab and the utility of progression-free survival. Probabilistic sensitivity analysis indicated a 0% probability that tarlatamab would be cost-effective at the WTP threshold of $150,000/QALY. A price reduction of more than 82.34% would be required for tarlatamab to achieve cost‑effectiveness. CONCLUSIONS: Tarlatamab is unlikely to be cost‑effective as a second‑line treatment for SCLC after platinum‑based chemotherapy at its current price. Substantial price reductions may be necessary for tarlatamab to become cost-effective.