Cost-effectiveness analysis of atezolizumab in patients with non-small-cell lung cancer ineligible for treatment with a platinum-containing regimen: a United Kingdom health care perspective

Yunlin Jiang; Mingye Zhao; Jiayi Xi; Jiaqi Li; Wenxi Tang; Xueping Zheng

doi:10.3389/fpubh.2023.1282374

Cost-effectiveness analysis of atezolizumab in patients with non-small-cell lung cancer ineligible for treatment with a platinum-containing regimen: a United Kingdom health care perspective

Front Public Health. 2023 Sep 29:11:1282374. doi: 10.3389/fpubh.2023.1282374. eCollection 2023.

Authors

Yunlin Jiang^{1

2}, Mingye Zhao³, Jiayi Xi³, Jiaqi Li³, Wenxi Tang³, Xueping Zheng¹

Affiliations

¹ Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China.
² Nanjing University of Chinese Medicine, Nanjing, China.
³ Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China.

Abstract

Background: Cost-effectiveness of atezolizumab, as a treatment for advanced non-small-cell lung cancer (NSCLC) patients who cannot receive a platinum-containing regimen,was still unknown. Our objective was to evaluate the cost-effectiveness of atezolizumab vs. chemotherapy in this indication from the perspective of UK healthcare system.

Methods: From the global, randomised, open-label, phase III IPSOS trial, clinical inputs and patient characteristics were obtained. A partitioned survival model with three health states was built: Progression-free survival, progressed disease and death. A lifetime time horizon was applied, with an annual discount rate of 3.5%. Additionally, the willingness-to-pay threshold of £50,000/QALY was utilized. Primary outcomes were quality-adjusted life-year (QALY), costs, and incremental cost-effectiveness ratio (ICER). Sensitivity, scenario, and subgroup analyses were used to assess the reliability of base-case results. Price simulations were carried out in order to provide information for the pricing strategy at specific willingness-to-pay threshold.

Results: In the base-case analysis, atezolizumab resulted in a gain of 0.28 QALYs and an ICER of £94,873/QALY compared to chemotherapy, demonstrating no cost-effectiveness. Price simulation results revealed that atezolizumab would be preferred at a price lower than £2,215 (a reduction of 41.8%) at the willingness-to-pay threshold of £50,000. Sensitivity, scenario and subgroup analyses revealed these conclusions were generally robust, the model was most sensitive to the price of atezolizumab and subsequent medication. Furthermore, atezolizumab was found to be more cost-effective for patients displaying a positive PD-L1 expression, with an ICER of £72,098/QALY as compared to chemotherapy.

Conclusion: Atezolizumab is not cost-effective for patients with advanced NSCLC ineligible for platinum-containing regimen, potential price reduction is necessary.

Keywords: UK; atezolizumab; cost-effectiveness; non-small-cell lung cancer; platinum-ineligible; price simulation.

MeSH terms

Carcinoma, Non-Small-Cell Lung* / drug therapy
Cost-Benefit Analysis
Cost-Effectiveness Analysis
Delivery of Health Care
Humans
Lung Neoplasms* / drug therapy
Platinum / therapeutic use
Reproducibility of Results

Substances

atezolizumab
Platinum

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the General Program of National Natural Science Foundation of China (grant no. 72174207), provided by WT. No potential biases to declare in this research.