Datopotamab deruxtecan versus docetaxel in previously treated advanced or metastatic non-small cell lung cancer: A cost-effectiveness analysis

•The cost-effectiveness of datopotamab deruxtecan was assessed in advanced or metastatic NSCLC.•Datopotamab deruxtecan significantly improves PFS and OS in previously treated stage IIIB, IIIC, or IV NSCLC.•The ICER of datopotamab deruxtecan versus docetaxel was estimated to be $80119/QALY in the US and $115643/QALY in China.•Datopotamab deruxtecan will reshape the subsequent treatment landscape of advanced or metastatic NSCLC worldwide. The TROPION-Lung-01 trial demonstrated that datopotamab deruxtecan (Dato-DXd) produced significantly longer progression-free survival (PFS) than docetaxel (DXT) in previously treated advanced/metastatic non-small cell lung cancer (NSCLC). Dato-DXd will be the first novel trophoblast cell surface antigen 2 (TROP-2) directed antibody-drug conjugate approved for NSCLC. Nevertheless, its expensive pricing may impose a significant financial burden on patients and healthcare systems worldwide. This study aimed to investigate the cost and efficacy of Dato-DXd for previously treated advanced/metastatic NSCLC from the perspectives of payers in the United States (US) and China. We established a Markov model, based on data from the TROPION-Lung-01 trial, to assess the cost and efficacy of Dato-DXd versus DXT for treated advanced/metastatic NSCLC. The main outcomes were quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Direct medical costs and utility values were sourced from published literature, the US government database, and local databases. We validated the robustness of this model through sensitivity analyses. Compared to DXT, patients with previously treated, stage IIIB, IIIC, or IV NSCLC treated with Dato-DXd saw an increase of 0.47 QALYs in the US and 0.68 QALYs in China for intention-to-treat populations, leading to an ICER of $80119/QALY in the US and $115643/QALY in China, respectively. In subgroup analysis, the ICERs of Dato-DXd versus DXT were $40485/QALY in SCC and $87070/QALY in NSCC populations in the US. In China, the ICERs were $96721 /QALY and $121223/QALY in SCC and NSCC populations, respectively. The sensitivity analyses confirmed the robustness of our models. In the US, Dato-DXd proved cost-effective compared to DXT for previously treated stage IIIB, IIIC, or IV NSCLC patients. However, in China, Dato-Dxd is not considered economical for this patient subset. To reach the cost-effectiveness threshold in China, the pricing of the Dato-DXd at $8.973 per mg is required.