Cost-Effectiveness Analysis of Atezolizumab Versus Chemotherapy as First-Line Treatment for Metastatic Non-Small-Cell Lung Cancer With Different PD-L1 Expression Status

Abstract

BackgroundAtezolizumab could significantly improve clinical outcomes and was associated with less toxicity compared with chemotherapy as the first-line treatment of PD-L1-selected patients with EGFR and ALK wild-type metastatic non-small-cell lung cancer (NSCLC). However, the economic outcomes remain unclear yet in China. This study aimed to investigate the cost-effectiveness of atezolizumab versus chemotherapy as first-line therapy for metastatic NSCLC with different PD-L1 expression status from the Chinese health sector perspective.MethodsA decision-analytic model was conducted to evaluate the economic outcomes for the first-line treatment of EGFR and ALK wild-type metastatic NSCLC with atezolizumab and chemotherapy in high PD-L1 expression, high or intermediate PD-L1 expression and any PD-L1 expression populations, respectively. The efficacy and safety data were obtained from the IMpower110 trial. Cost and utility values were gathered from the local charges and published literatures. Incremental cost-effectiveness ratio (ICER) was estimated. A scenario analysis for a patient assistance program (PAP) was conducted. One-way and probabilistic sensitivity analyses were performed to explore the robustness of the model results.ResultsAtezolizumab yielded additional 0.91 QALYs, 0.57 QALYs, 0.42 QALYs in comparison with chemotherapy, and the ICERs were $123,778.60/QALY, $142,827.19/QALY, $168,902.66/QALY in the high PD-L1 expression, high or intermediate PD-L1 expression, and any PD-L1 expression populations, respectively. When PAP was available, the ICERs were $52,414.63/QALY, $52,329.73/QALY, $61,189.66/QALY in the three categories of PD-L1 expression status populations, respectively. The ICERs were exceed the willingness-to-pay (WTP) threshold of $30,828/QALY (three times of per capita gross domestic product of China in 2019) in China. One-way sensitivity analyses suggested that the cost of atezolizumab played a vital role in the model outcomes, and the probabilistic sensitivity analyses showed atezolizumab was unlikely to be cost-effective at the WTP threshold regardless of PD-L1 expression status and whether the PAP was available or not.ConclusionsAtezolizumab as first-line treatment for PD-L1-selected metastatic NSCLC patients without EGFR mutations or ALK translocations is unlikely to be cost-effective compared with chemotherapy regardless of PD-L1 expression status in the Chinese context.

Cost-effectiveness analysis of adjuvant therapy with atezolizumab in Chinese patients with stage IB-IIIA resectable NSCLC after adjuvant chemotherapy

“…First, the KM survival curve was obtained from the IMpower010 trial to extrapolate the longterm clinical effect of the drug by fitting a parameter function, and the extrapolation time exceeded the real follow-up time of the trial, incurring inevitable limitations and perhaps lead to deviations between the model results and the actual situation. Second, some key clinical costs were derived from the literature rather than survey data from this study (34)(35)(36)(37)(38)(39)(40), such as the subsequent treatment cost of PD, considering only the cost of grade III/IV adverse events reported by ≥ 1% of patients in the IMpower010 trial, this may lead to inaccurate estimates of AE costs. By changing the model input within a certain range to run the probability sensitivity analysis, it was found that ICER was not sensitive to AE cost.…”

Benefits of precision medicine in lung cancer: experience from a single institution

“…Compared with no tumor profiling in patients with metastatic lung adenocarcinoma, tumor profiling improves quality-adjusted survival, but it is not cost-effective, especially in the wild type and where there is a rare mutation [17]. This situation could be improved by expanding the coverage of medical insurance and supplementary commercial insurance for targeted drugs and immunotherapy [18].…”

Cost-effectiveness analysis of sintilimab plus chemotherapy versus chemotherapy alone for the first-line treatment of advanced oesophageal squamous cell carcinoma

“…After disease progression, all patients had the same opportunity to receive second-line treatment according to the guidelines of the Chinese Society of Clinical Oncology (CSCO) for oesophageal cancer (2021) [20] and the ORIENT-15 data [10]. All costs were obtained from local hospitals and previously published literature [21][22][23][24][25][26][27][28]. All costs were adjusted to US dollars in 2021 ($1 = 6.45…”

“…The utility values for health states in the model were derived from a worldwide, randomized, double-blind phase III clinical study that recruited patients with advanced gastric cancer or gastroesophageal junction adenocarcinoma [22,29]. The disutility caused by adverse events was also considered in this cost-effectiveness analysis [21,27]. The key model parameters are shown in Table 2.…”