Cost-effectiveness of second-line atezolizumab in Canada for advanced non-small cell lung cancer (NSCLC)

Ondhia, Umang; Conter, Henry Jacob; Owen, Scott; Zhou, Anna; Nam, Julian; Singh, Sumeet; Abdulla, Ahmed M.; Chu, Paula; Felizzi, Federico; Paracha, Noman; Sangha, Randeep

doi:10.1080/13696998.2019.1590842

Cited by 25 publications

(28 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several fractional polynomial meta-analyses were conducted comparing atezolizumab with nivolumab to benchmark their respective effectiveness 18,22,28 . Evidences varied according to the type of analyses, never reached a meaningful difference, and were always associated with a minor effect size (always less than 1 month).…”

Section: Discussionmentioning

confidence: 99%

“…In the USA, based on four RCTs, in comparison to docetaxel, the Quality adjusted life years (QALY) gain for atezolizumab was 0.354 and the incremental cost-effectiveness ratio (ICER) was $215,802 17 . Based on the results of the OAK study and using a network meta-analysis, Ondhia et al 18 evaluated efficiency of atezolizumab in Canada. They reported a gain QALYs of 0.60 for atezolizumab compared with docetaxel at an incremental cost of $85,073 based on a 10 years horizon, resulting in an ICER of $1,42,074/QALY.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Marine¹,

Roze²,

Plommet

et al. 2020

Journal of Medical Economics

Self Cite

View full text Add to dashboard Cite

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

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Marine¹,

Roze²,

Plommet

et al. 2020

Journal of Medical Economics

Self Cite

View full text Add to dashboard Cite

show abstract

“…The costs were higher per QALY for the combination pembrolizumabchemotherapy in PDL1 negative NSCLC (183,529$) than for intermediate PDL1 expression (66,837$) ( Table 7). The last study was conducted in Canada, using the data from the OAK trial (82). Second line atezolizumab showed incremental costs (in Canadian dollars) per QALY of 142,074$.…”

Section: Is Immunotherapy Cost-effective?mentioning

confidence: 99%

Immunotherapy: From Advanced NSCLC to Early Stages, an Evolving Concept

et al. 2020

View full text Add to dashboard Cite

Immunotherapy in lung cancer treatment is a long history paved with failures and some successes. During the last decade, the discovery of checkpoints inhibitors led to major advances in treating advanced and metastatic non-small cell lung cancer (NSCLC). Impressive data from early phase I-II studies were subsequently confirmed in large prospective randomized trials and meta-analyses (High-level of evidence). Three anti-programmed death-1 (PD1) (pembrolizumab, nivolumab) or antiPD-ligand(L)1 (atezolizumab) antibodies showed clinically significant improved survival compared to second-line docetaxel. Then, first-line pembrolizumab monotherapy demonstrated its superiority over platinum-doublet in high PD-L1 NSCLC. The addition of pembrolizumab or atezolizumab to chemotherapy derived the same results regardless of the PD-L1 status. On the opposite, antiCTLA4 (Cytotoxic T-Lymphocyte Associated 4) results are currently disappointing in unselected patients while recent development suggest that the combination of antiPD1 and antiCTLA4 (nivolumab-ipilimumab) positively impact on overall survival. Some secondary analyses also showed that immunotherapy has a positive impact on quality of life and that the clinical improvement can be done at an acceptable incremental cost per QALY. A lot of questions remain unresolved: which is the best treatment duration and is it the same for all patients, how to choose the patients that will have the highest benefit of immunotherapy, how to identify the patients who will have rapid progression, how to improve the current data (new targets, new combinations)…

show abstract

“…Huang et al [24] found that pembrolizumab is cost-effective versus docetaxel in pre-treated advanced NSCLC patients with PD-L1 � 50% from the US third-party payer perspective. Additionally, atezolizumab was proved to be a cost-effective therapeutic option in Canada for the treatment of patients with advanced NSCLC who progressed after first-line chemotherapy [37]. Given various options for second-line treatment of advanced NSCLC, Aguiar et al [22] assessed the cost-effectiveness and economic impact of PD-L1 testing and the above-mentioned three second-line ICIs versus docetaxel.…”

Section: Plos Onementioning

confidence: 99%

Cost effectiveness of immune checkpoint inhibitors for treatment of non-small cell lung cancer: A systematic review

et al. 2020

View full text Add to dashboard Cite

Background Immune checkpoint inhibitors (ICIs) for treatment of non-small cell lung cancer (NSCLC) have been rapidly evolving. ICIs are likely to be more effective but also lead to escalating healthcare costs. Objectives The aim of this study was to evaluate the cost effectiveness of immune checkpoint inhibitors (ICIs) for treatment of non-small cell lung cancer (NSCLC). Methods We searched the PubMed, Web of Science, and Cochrane Library for studies comparing the cost effectiveness of ICIs for NSCLC. Potential studies identified were independently checked for eligibility by two authors, with disagreement resolved by a third reviewer. Quality of the included studies was evaluated using Consolidated Health Economic Evaluation Reporting Standards checklists. Results A total of 22 economic studies were included. Overall reporting of the identified studies largely met CHEERS recommendations. In the first-line setting, for advanced or metastatic NSCLC patients with PD-L1 � 50%, pembrolizumab appeared cost-effective compared with platinum-based chemotherapy in the US and Hong Kong (China), but not in the UK and China. The cost-effectiveness of pembrolizumab versus chemotherapy for first-line treatment of NSCLC in PD-L1 � 1% patients remained obscure. Regardless of PD-L1 expression status, pembrolizumab in combination with chemotherapy could be a cost-effective first-line therapy in the US. On the contrary, addition of atezolizumab to the combination of

show abstract

Cost-effectiveness of second-line atezolizumab in Canada for advanced non-small cell lung cancer (NSCLC)

Cited by 25 publications

References 33 publications

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

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

Immunotherapy: From Advanced NSCLC to Early Stages, an Evolving Concept

Cost effectiveness of immune checkpoint inhibitors for treatment of non-small cell lung cancer: A systematic review

Contact Info

Product

Resources

About