Cost-effectiveness of pirfenidone for patients with cancer and grade 2 or grade 3 radiation-induced lung injury: A modeling study

Research conducted by Qiu-Yi Pan and colleagues investigates the cost-effectiveness of pirfenidone in treating grade 2 or 3 radiation-induced lung injury (RILI) in cancer patients. The study builds upon a phase II randomized clinical trial, demonstrating pirfenidone's safety and efficacy in managing RILI.

A Markov model, constructed using data from the trial (NCT03902509), simulates the treatment's cost-effectiveness over a 24-week period, with outcomes measured in quality-adjusted life years (QALYs). The analysis is discounted at a 3% annual rate. Costs and health outcomes are compared between pirfenidone plus glucocorticoids and glucocorticoids alone.

The results indicate that adding pirfenidone to glucocorticoids yields an additional 0.028 QALYs at a cost of $590 per treatment cycle, resulting in an ICER of $20,956 per QALY. This ICER falls well below the commonly accepted threshold of $100,000 per QALY, suggesting the strategy is cost-effective. Sensitivity analyses reveal that acute pulmonary exacerbation-free survival and the likelihood of non-response to glucocorticoids are key factors affecting the ICER.

The probabilistic sensitivity analysis indicates a 99.98% probability that pirfenidone plus glucocorticoids are cost-effective up to a WTP threshold of $100,000 per QALY. However, the study acknowledges limitations, such as relying on phase II trial data with a small sample size and follow-up. An ongoing phase III trial will further substantiate these findings.

In conclusion, for patients with grade 2 or 3 RILI, pirfenidone combined with glucocorticoids proves to be a cost-effective treatment option, offering a viable clinical management strategy for this condition.