First‐line atezolizumab in addition to bevacizumab plus chemotherapy for metastatic, nonsquamous non–small cell lung cancer: A United States–based cost‐effectiveness analysis

Abstract

BACKGROUND:The IMpower150 trial found that adding atezolizumab to the combination of bevacizumab and chemotherapy improved survival for patients with metastatic, nonsquamous non-small cell lung cancer (NSCLC). However, considering the high cost of immunotherapy, there is a need to assess its value by considering both efficacy and cost. The current study evaluated the cost-effectiveness of atezolizumab in the first-line setting for the treatment of patients with metastatic NSCLC from the US payer perspective. METHODS: A Markov model was developed to compare the lifetime cost and effectiveness of the combination of atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP) with the combination of bevacizumab, carboplatin, and paclitaxel (BCP) and carboplatin and paclitaxel (CP) in the first-line treatment of patients with metastatic NSCLC. Life-years (LYs), qualityadjusted LYs (QALYs), and lifetime costs were estimated. One-way and probabilistic sensitivity analyses were performed to evaluate the model uncertainty. Additional subgroup analyses were performed. RESULTS: ABCP provided an additional 0.413 QALYs (0.460 LYs) and 0.738 QALYs (0.956 LYs), respectively, compared with BCP and CP. The corresponding incremental costs were $234,998 and $381,116, respectively. The incremental cost-effectiveness ratio for ABCP was $568,967 per QALY compared with BCP and $516,114 per QALY compared with CP. The subgroup analysis demonstrated that PD-L1 expression of ≥50% on tumor cells (TC3) or ≥10% on immune cells (IC3) decreased the incremental cost-effectiveness ratio to $464,703 per QALY. CONCLUSIONS: From the perspective of the US payer, ABCP is estimated to not be cost-effective compared with BCP or CP in the first-line setting for patients with metastatic, nonsquamous NSCLC at a willingness-to-pay threshold of $100,000 per QALY. Cancer 2019;125:3526-3534.

Apatinib plus Chemotherapy as a Second-Line Treatment in Unresectable Non-Small Cell Lung Carcinoma: A Randomized, Controlled, Multicenter Clinical Trial

“…Previous studies on antiangiogenesis therapeutic drugs mostly excluded patients with squamous cell carcinoma because of the potential risk of life‐threatening pulmonary hemorrhage [17–20]. However, the present study included patients with lung squamous cell carcinoma, but no fatal bleeding events were observed.…”

Antiangiogeneic Strategies in Mesothelioma

“…Chinese and US studies were inconclusive, each with both positive and negative studies (87)(88)(89)(90)(91)(92)(93). However, a recent cost-effectiveness study from the IMpower 150 trial, using a Markov model, showed improved cost-effectiveness of an atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP) combination over bevacizumab, carboplatin, and paclitaxel (BCP) and carboplatin and paclitaxel (CP) in the first-line treatment of patients with metastatic NSCLC (94). It is difficult to directly extrapolate to mesothelioma patients from NSCLC data, since people with mesothelioma are generally older, but conversely have fewer smoking induced comorbidities.…”

Cost effectiveness of immune checkpoint inhibitors for treatment of non-small cell lung cancer: A systematic review

“…The characteristics of all included studies are presented in S1 Table. Most of the studies were conducted in 2019 [28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Studies were conducted from countries all over the world, with ten from the USA [22-27, 29, 30, 32, 33], seven from China (one from HongKong) [34][35][36][38][39][40][41], two from Canada [20,37], and one each from Australia [31], France [28] and Switzerland [21]. Most studies were assessed from the perspective of health care system (N = 12) [20-22, 25, 26, 28-31, 35, 37, 40], some used a payer perspective (N = 8) [23,24,27,32,33,38,39,41], and the remainder used a perspective of society (N = 1) [34] and hospital authority (N = 1) [36].…”