Cost-Effectiveness of Telisotuzumab Vedotin-tllv for Previously Treated High c-Met Protein-Overexpressing Nonsquamous Non-Small Cell Lung Cancer in the United States.

OBJECTIVES

To estimate the incremental cost-effectiveness of telisotuzumab vedotin-tllv (teliso-V) versus docetaxel in previously treated high c-Met protein-overexpressing (≥50% of tumor cells with 3+ staining) advanced nonsquamous non-small cell lung cancer.

METHODS

A partitioned survival model with monthly cycles and a five-year horizon was built from the US healthcare sector perspective. Individual time-to-event data were reconstructed from published Kaplan-Meier curves of the c-Met High subgroup (N=78) of LUMINOSITY and the CONTACT-01 docetaxel arm (N=180). Because individual covariate data were unavailable, a naive (unadjusted) indirect comparison was conducted. Seven parametric distributions were fit independently by arm; their median and range were the primary summary. The analysis was preregistered.

RESULTS

The unadjusted overall survival hazard ratio favored teliso-V but was not statistically significant (HR 0.690; 95% CI 0.471-1.010). The median incremental cost-effectiveness ratio was approximately $2.0 million per QALY (range, $1.7-$2.2 million). Across 70,000 probabilistic iterations, cost-effectiveness was not achieved in any iteration at $50,000, $100,000, $150,000, or $200,000 per QALY. The threshold payment limit at $150,000 per QALY was approximately $1,209 per 100 mg (92% reduction).

CONCLUSIONS

At the current Medicare Part B payment limit, telisotuzumab vedotin-tllv is unlikely to be cost-effective versus docetaxel in the US high c-Met protein-overexpressing population at conventional willingness-to-pay thresholds. The conclusion was robust to modeled survival extrapolation and parameter uncertainty. Because the comparison is unadjusted, comparative effectiveness remains uncertain pending randomized results.