Format

Send to

Choose Destination
Cancer. 2019 Jul 9. doi: 10.1002/cncr.32368. [Epub ahead of print]

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

Wan X1,2, Luo X1,2, Tan C1,2, Zeng X3, Zhang Y1,2, Peng L1,2.

Author information

1
Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
2
Institute of Clinical Pharmacy, Central South University, Changsha, Hunan, China.
3
The PET-CT Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.

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), quality-adjusted 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.

KEYWORDS:

atezolizumab; bevacizumab; cost-effectiveness; non-small cell lung cancer

PMID:
31287562
DOI:
10.1002/cncr.32368

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center