Cost-effectiveness analysis of atezolizumab plus chemotherapy in the first line treatment of extensive-stage small-cell lung cancer

Objectives: A double-blind, placebo-controlled, phase 3 trial has shown atezolizumab plus chemotherapy in the first-line treatment of extensive-stage small-cell lung cancer could significantly prolong overall survival and progression-free survival than chemotherapy alone. This study aimed to assess the cost-effectiveness of atezolizumab plus chemotherapy as first-line treatment for patients with extensive-stage small-cell lung from an American perspective. Materials and methods: Basic medical information was derived from the double-blind, placebo-controlled, phase 3 trial (IMpowerl 33, NCT02763579). A Markov model was developed to simulate the process of small-cell lung cancer, including three health states: progression-free survival (PFS), progressive disease (PD), and death. Utilities and costs were obtained from published resources. Sensitivity analyses were applied to explore the impact of essential variables. Results: Treatment with atezolizumab plus chemotherapy was estimated to increase costs by $52,881compared with chemotherapy alone, with a gain of 0.10 quality adjusted life years (QALYs), leading to an incremental cost-effective ratio of $528,810 per QALY. The cost of PFS state and atezolizumab were the most influential factors to the model. Conclusion: The combination of atezolizumab, carboplatin and etoposide is not a cost-effective choice in the first-line treatment of extensive-stage SCLC from an American perspective.