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Cost-Effectiveness Analysis of Atezolizumab Plus Chemotherapy in the First-Line Treatment of Metastatic Non-Squamous Non-Small Cell Lung Cancer



The purpose of this study was to estimate the cost-effectiveness of atezolizumab plus chemotherapy in patients with metastatic non-squamous non-small cell lung cancer (NSCLC) from the United States (US) payers’ perspective in the first-line treatment.


A mathematical Markov model was developed to estimate cost and effectiveness of atezolizumab combination therapy versus carboplatin plus nab-paclitaxel alone in the first-line therapy of metastatic non-squamous NSCLC from the data of IMpower130. Costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were analyzed, and model robustness was assessed by sensitivity analysis. Additional subgroup analyses were performed as well.


Compared to chemotherapy, treatment with atezolizumab plus chemotherapy yields an increase of 0.16 QALYs with an increase in cost of $109,809.13, resulting in an ICER of $670,309.66 per QALY. The most influential factor in this model was the cost of atezolizumab. Probabilistic sensitivity analysis showed that there was 0% probability that atezolizumab plus chemotherapy was cost-effective at willingness-to-pay (WTP) values of $150,000 per QALY. The results of subgroup analyses showed that the ICER remained greater than $150,000/QALY across the all patient subgroups.


First-line treatment with atezolizumab in combination with carboplatin plus nab-paclitaxel is not a cost-effective option in patients with metastatic non-squamous NSCLC.

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This manuscript, including the journal’s Rapid Service Fee, was supported by grants from the Hunan Natural Science Foundation of China (No. 2018JJ3852). All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.


Dong Ding, Huabin Hu, Mengting Liao, Yin Shi, Longjiang She, Linli Yao, Youwen Zhu, Shan Zeng, and Jin Huang have nothing to disclose.

Compliance with Ethics Guidelines

The model structure and data were based on results of IMpower130, the US publicly available databases, and published literature. As such, this article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors and did not require the approval of an independent ethics committee.

Data Availability

All data generated or analyzed during this study are available from the corresponding author on reasonable request.

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Correspondence to Jin Huang.

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Ding, D., Hu, H., Liao, M. et al. Cost-Effectiveness Analysis of Atezolizumab Plus Chemotherapy in the First-Line Treatment of Metastatic Non-Squamous Non-Small Cell Lung Cancer. Adv Ther 37, 2116–2126 (2020).

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  • Atezolizumab
  • Cost-effectiveness
  • Non-small cell lung cancer
  • Oncology