Cost-effectiveness of atezolizumab plus chemotherapy for advanced non-small-cell lung cancer

被引：43

作者：

Lin, Shen ^{[1
]}

Luo, Shaohong ^{[1
]}

Zhong, Lixian ^{[2
]}

Lai, Shubin ^{[1
]}

Zeng, Dayong ^{[1
]}

Rao, Xin ^{[1
]}

Huang, Pinfang ^{[1
]}

Weng, Xiuhua ^{[1
]}

机构：

[1] Fujian Med Univ, Affiliated Hosp 1, Dept Pharm, Chazhong Rd 20, Fuzhou, Fujian, Peoples R China

[2] Texas A&M Univ, Coll Pharm, College Stn, TX USA

来源：

INTERNATIONAL JOURNAL OF CLINICAL PHARMACY | 2020年 / 42卷 / 04期

关键词：

Atezolizumab; Cost-effectiveness; First-line therapy; Non-squamous non-small-cell lung cancer; HEALTH STATE UTILITIES; PHASE-III; PEMBROLIZUMAB; BEVACIZUMAB; CARBOPLATIN; PACLITAXEL; CISPLATIN; DOCETAXEL;

D O I：

10.1007/s11096-020-01076-3

中图分类号：

R9 [药学];

学科分类号：

1007 ;

摘要：

BackgroundAdding atezolizumab to carboplatin/nab-paclitaxel improved progression-free survival and overall survival in patients with advanced non-squamous non-small-cell lung cancer. However, estimating the economy of atezolizumab/carboplatin/nab-paclitaxel is urgent on account of the high cost of atezolizumab.ObjectiveThis study aimed to evaluate the cost-effectiveness of atezolizumab plus carboplatin/nab- paclitaxel for untreated advanced non-squamous non-small-cell lung cancer from the United States payer perspective.SettingThis study was based on randomized clinical trial data from the IMpower130 (NCT02367781) published in Lancet Oncology (May 2019).MethodA Markov model was constructed to estimate the health expenditure on atezolizumab in combination with carboplatin/nab-paclitaxel for advanced non-small-cell lung cancer treatment. Drug costs were collected from Red Book Wholesale Acquisition Cost, and health state utility values were obtained from the literature. Uncertainty was evaluated via one-way and probabilistic sensitivity analyses.Main outcome measureThe main outcomes were cost, life years, quality-adjusted life years, and incremental cost-effectiveness ratio.ResultsOver a 10-year horizon, atezolizumab/carboplatin/nab-paclitaxel treatment was associated with an expected 1.76 life years and 0.99 quality-adjusted life years compared to the 1.21 life years and 0.67 quality-adjusted life years for carboplatin/nab-paclitaxel alone. Compared to carboplatin/nab-paclitaxel, atezolizumab/carboplatin/nab-paclitaxel produced an incremental cost of $105,617. The resultant incremental cost-effectiveness ratio was $333,199 per quality-adjusted life year, which exceeded the willingness-to-pay threshold of $180,000 per quality-adjusted life year. The price of atezolizumab and utility values were the parameters that greatly impacted the incremental cost-effectiveness ratio. Carboplatin/nab-paclitaxel exhibited 98.6% probability of being a cost-effective treatment option compared to atezolizumab/carboplatin/nab-paclitaxel at a willingness-to-pay of $180,000 per quality-adjusted life year. However, reducing atezolizumab acquisition cost by 43.4% could make atezolizumab/carboplatin/nab-paclitaxel more cost-effective than carboplatin/nab-paclitaxel.ConclusionAdding atezolizumab to carboplatin/nab-paclitaxel was not cost-effective for advanced non-squamous non-small-cell lung cancer in the base-case scenario. Decreasing atezolizumab acquisition cost might enhance the cost-effectiveness.

引用

页码：1175 / 1183

页数：9

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