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Lung Cancer. 2019 Apr;130:1-4. doi: 10.1016/j.lungcan.2019.01.019. Epub 2019 Feb 1.

Cost-effectiveness analysis of atezolizumab plus chemotherapy in the first-line treatment of extensive-stage small-cell lung cancer.

Author information

1
Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, No. 37, GuoXue Xiang Chengdu, Sichuan, 610041, China; West China Biomedical Big Data Center, Sichuan University, No. 37, GuoXue Xiang Chengdu, Sichuan, 610041, China.
2
Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, No. 37, GuoXue Xiang Chengdu, Sichuan, 610041, China; West China Biomedical Big Data Center, Sichuan University, No. 37, GuoXue Xiang Chengdu, Sichuan, 610041, China. Electronic address: fbqiu9@163.com.

Abstract

OBJECTIVES:

A double-blind, placebo-controlled, phase 3 trial has shown atezolizumab plus chemotherapy in the first-line treatment of extensive-stage small-cell lung cancer could significantly prolong overall survival and progression-free survival than chemotherapy alone. This study aimed to assess the cost-effectiveness of atezolizumab plus chemotherapy as first-line treatment for patients with extensive-stage small-cell lung from an American perspective.

MATERIALS AND METHODS:

Basic medical information was derived from the double-blind, placebo-controlled, phase 3 trial (IMpower133, NCT02763579). A Markov model was developed to simulate the process of small-cell lung cancer, including three health states: progression-free survival (PFS), progressive disease (PD), and death. Utilities and costs were obtained from published resources. Sensitivity analyses were applied to explore the impact of essential variables.

RESULTS:

Treatment with atezolizumab plus chemotherapy was estimated to increase costs by $52,881compared with chemotherapy alone, with a gain of 0.10 quality adjusted life years (QALYs), leading to an incremental cost-effective ratio of $528,810 per QALY. The cost of PFS state and atezolizumab were the most influential factors to the model.

CONCLUSION:

The combination of atezolizumab, carboplatin and etoposide is not a cost-effective choice in the first-line treatment of extensive-stage SCLC from an American perspective.

KEYWORDS:

Atezolizumab plus chemotherapy; Cost-effectiveness; Extensive-stage small-cell lung cancer; First-line treatment

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