Cost-effectiveness of atezolizumab versus docetaxel and nivolumab in the treatment of non-small cell lung cancer as a second line in France

Abstract

Aim: To estimate the cost-effectiveness of atezolizumab compared with docetaxel and nivolumab for the treatment of advanced non-small cell lung cancer (NSCLC), as a second-line treatment, in a French setting. Materials and methods: A three-state partitioned-survival model was developed (progression-free survival, post-progression survival, death) based on the phase IIIOAK trial on a 10-year time horizon. The comparison between nivolumab and atezolizumab came from a network meta-analysis. Utilities were estimated from the OAK trial EQ-5D applying the French utility tariffs. Overall survival (OS), progression-free survival (PFS), and treatment duration were estimated using parametric models selected using Akaike and Bayesian information criterion. Extrapolation beyond the trial duration followed NICE DSU TSD 14. Economic perspective was the one of all payers, discount rate fixed at 4% on benefits and costs. This analysis was aligned with French Haute Autorit e de Sant e recommendations. Results were expressed in total cost (2019) and e/QALY (Quality Adjusted Life Year). Model robustness was checked through sensitivity analyses, and a probabilistic sensitivity analysis was conducted. Results: In comparison to docetaxel, atezolizumab costs 49,429e more and increased life expectancy by 8 months, generating 0.47 QALY. Incremental cost-effectiveness ratio was estimated at 104,835e/ QALY. When comparing nivolumab to atezolizumab, a cost minimization analysis was conducted since no clear evidence supporting a difference in terms of survival benefit was reported. Using list price, and the Market Access Authorization regimens, atezolizumab saved approximately 6,000e, 9.5% of its total costs. Sensitivity analyses confirmed the robustness of our findings. Conclusion: Atezolizumab is more efficient and more costly than docetaxel in the second-line treatment of NSCLC of stage IIIB or IV, in France, with results consistent to previous French authorities' evaluation of immunotherapies in similar indication. Lastly, atezolizumab is a cost saving alternative to nivolumab, based on list price. ARTICLE HISTORY

Atezolizumab and bevacizumab combination compared with sorafenib as the first‐line systemic treatment for patients with unresectable hepatocellular carcinoma: A cost‐effectiveness analysis in China and the United states

“…To date, several cost-effectiveness analyses of atezolizumab have been published, most focused on lung and breast cancers, from the payers' perspective in the USA, China, France and Canada. [28][29][30][31] The majority of findings were similar to ours, indicating that although immunotherapy appeared to be promising in terms of effectiveness in clinical practice, it is still an expensive alternative to the current standard of care. Therefore, a reduction in price is warranted to make the combination of atezolizumab and bevacizumab costeffective and affordable.…”

Effectiveness and Cost-Effectiveness Profile of Second-Line Treatments with Nivolumab, Pembrolizumab and Atezolizumab in Patients with Advanced Non-Small Cell Lung Cancer

“…Among the three immune checkpoint inhibitors currently approved for treating advanced NSCLC, atezolizumab is the therapy associated with lower healthcare costs in the Lombardy setting. This data is consistent with a French cost-effectiveness study that concluded that atezolizumab is a cost-saving alternative to nivolumab, based on list price [15]. The cost-effectiveness of atezolizumab versus nivolumab for second-line treatment was also evaluated in a recent Canadian study based on RCT data, in which atezolizumab was more effective and less costly than nivolumab, although based on a modest difference in quality-adjusted life years (QALYs) and costs [16].…”

The progress and challenge of anti-PD-1/PD-L1 immunotherapy in treating non-small cell lung cancer

“…59 Their results indicated that atezolizumab was more efficacious and more costly than docetaxel in treating advanced NSCLC. 86 All studies that have assessed PD-1/PD-L1 inhibitors as secondline therapies are summarised in Table 3.…”