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Cost-effectiveness of atezolizumab plus chemotherapy for advanced non-small-cell lung cancer

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Abstract

Background Adding atezolizumab to carboplatin/nab-paclitaxel improved progression-free survival and overall survival in patients with advanced non-squamous non-small-cell lung cancer. However, estimating the economy of atezolizumab/carboplatin/nab-paclitaxel is urgent on account of the high cost of atezolizumab. Objective This study aimed to evaluate the cost-effectiveness of atezolizumab plus carboplatin/nab- paclitaxel for untreated advanced non-squamous non-small-cell lung cancer from the United States payer perspective. Setting This study was based on randomized clinical trial data from the IMpower130 (NCT02367781) published in Lancet Oncology (May 2019). Method A Markov model was constructed to estimate the health expenditure on atezolizumab in combination with carboplatin/nab-paclitaxel for advanced non-small-cell lung cancer treatment. Drug costs were collected from Red Book Wholesale Acquisition Cost, and health state utility values were obtained from the literature. Uncertainty was evaluated via one-way and probabilistic sensitivity analyses. Main outcome measure The main outcomes were cost, life years, quality-adjusted life years, and incremental cost-effectiveness ratio. Results Over a 10-year horizon, atezolizumab/carboplatin/nab-paclitaxel treatment was associated with an expected 1.76 life years and 0.99 quality-adjusted life years compared to the 1.21 life years and 0.67 quality-adjusted life years for carboplatin/nab-paclitaxel alone. Compared to carboplatin/nab-paclitaxel, atezolizumab/carboplatin/nab-paclitaxel produced an incremental cost of $105,617. The resultant incremental cost-effectiveness ratio was $333,199 per quality-adjusted life year, which exceeded the willingness-to-pay threshold of $180,000 per quality-adjusted life year. The price of atezolizumab and utility values were the parameters that greatly impacted the incremental cost-effectiveness ratio. Carboplatin/nab-paclitaxel exhibited 98.6% probability of being a cost-effective treatment option compared to atezolizumab/carboplatin/nab-paclitaxel at a willingness-to-pay of $180,000 per quality-adjusted life year. However, reducing atezolizumab acquisition cost by 43.4% could make atezolizumab/carboplatin/nab-paclitaxel more cost-effective than carboplatin/nab-paclitaxel. Conclusion Adding atezolizumab to carboplatin/nab-paclitaxel was not cost-effective for advanced non-squamous non-small-cell lung cancer in the base-case scenario. Decreasing atezolizumab acquisition cost might enhance the cost-effectiveness.

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Acknowledgements

We thank for Vikas Narang from the Editage for proofreading this manuscript.

Funding

This work was supported by the Natural Science Foundation of Fujian Province (Grant No. 2019J01446) and the Startup Fund for Scientific Research, Fujian Medical University (Grant No. 2018QH1091).

Conflicts of interest

All authors declare that they have no conflicts of interest.

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All data generated or analyzed during this study are included in this published article.

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Author notes

  1. Shen Lin and Shaohong Luo contributed equally to this work.

Authors and Affiliations

  1. Department of Pharmacy, First Affiliated Hospital of Fujian Medical University, Chazhong Road NO. 20, Fuzhou, Fujian, People’s Republic of China

    Shen Lin, Shaohong Luo, Shubin Lai, Dayong Zeng, Xin Rao, Pinfang Huang & Xiuhua Weng

  2. College of Pharmacy, Texas A&M University, College Station, TX, USA

    Lixian Zhong

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Lin, S., Luo, S., Zhong, L. et al. Cost-effectiveness of atezolizumab plus chemotherapy for advanced non-small-cell lung cancer. Int J Clin Pharm 42, 1175–1183 (2020). https://doi.org/10.1007/s11096-020-01076-3

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