ArticleFrontiers in pharmacology2026
Cost-effectiveness of tarlatamab versus chemotherapy for patients with small-cell lung cancer after platinum-based chemotherapy in the United States and China.
Article in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and Objective: Small-cell lung cancer (SCLC) is highly aggressive, and outcomes after relapse following platinum-based therapy remain poor. Tarlatamab, a DLL3-targeted bispecific T-cell engager, has demonstrated survival benefits in phase III trials. Given rising oncology expenditures, we evaluated the cost-effectiveness of tarlatamab versus chemotherapy from U.S. and Chinese payer perspectives. Methods: We developed a three-state Markov model using efficacy inputs reconstructed from DeLLphi-304. Parametric survival extrapolation and Bayesian model averaging were applied over a lifetime horizon with 1-month cycles. Direct medical costs included drug acquisition and administration, monitoring, management of grade ≥3 adverse events, subsequent therapies, supportive care, and end-of-life care; utilities were obtained from published sources. Costs were expressed in 2025 U.S. dollars. Base-case willingness-to-pay (WTP) thresholds were $150,000 per quality-adjusted life-years (QALYs) (U.S.) and three times Results: Tarlatamab yielded a 0.15-QALY gain versus chemotherapy. Incremental costs were $198,914.10 in the United States and $61,878.59 in China, corresponding to ICERs of $1,306,254.68 and $406,352.26 per QALY, respectively-both exceeding country-specific WTP thresholds. ICERs increased monotonically with the drug price. Deterministic and probabilistic sensitivity analyses indicated robustness; no plausible parameter variation reduced ICERs below prespecified thresholds. Subgroup results paralleled survival benefits, but all subgroup ICERs remained above WTP thresholds. Conclusion: At current prices, tarlatamab is not cost-effective for SCLC after platinum-based therapy in the United States or China. Achieving cost-effectiveness would require prices at or below the thresholds identified in the simulations. Affordability constraints are more stringent in China than in the United States. These findings inform value-based pricing, reimbursement negotiations, and equitable access strategies.
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