Cheng Shuqiao, Pei Rui, Li Jianhuang, Li Bin, Tang Lanhua, Yin Tao, Liu Shao
Department of Pharmacy, Xiangya Hospital of Central South University, Changsha, China.
Department of Oncology, Xiangya Hospital of Central South University, Changsha, China.
Ann Transl Med. 2021 Sep;9(18):1481. doi: 10.21037/atm-21-4294.
The IMpower110 trial revealed that atezolizumab treatment had significantly longer overall survival (OS) than chemotherapy in non-small cell lung cancer (NSCLC) patients with high-programmed death ligand 1 (PD-L1) expression. The purpose of the present study was to estimate the cost-effectiveness of atezolizumab versus platinum-based chemotherapy for first-line treatment in metastatic NSCLC with high PD-L1 expression, from the perspective of US and Chinese payers.
A partitioned survival model was constructed based on information from the IMpower110 clinical trial to estimate cost-effectiveness of atezolizumab versus chemotherapy as first-line treatment of metastatic NSCLC. Costs were estimated from US and Chinese payer perspectives. The impact of uncertainty was explored by performing one-way and probabilistic sensitivity analyses.
In the United States, treatment with atezolizumab was estimated to increase 0.87 quality adjusted life years (QALYs) at a cost of $123,424/QALY. In China, the use of atezolizumab cost an additional $68,489 compared with chemotherapy, yielding an incremental cost-effectiveness ratio (ICER) of $78,936/QALY. Sensitivity analysis indicated that the cost of atezolizumab was the most influential factor in both countries.
In the United States, which had a willingness-to-pay (WTP) threshold of $100,000 to $150,000 per QALY, atezolizumab was a cost-effective strategy for first-line treatment in metastatic NSCLC patients with high PD-L1 expression when compared to chemotherapy. For China, with a WTP threshold of $33,210 per QALY, atezolizumab was not considered good-value treatment for NSCLC, and a price reduction of 52% appeared to be justified.
IMpower110试验显示，在程序性死亡配体1（PD-L1）高表达的非小细胞肺癌（NSCLC）患者中，阿替利珠单抗治疗的总生存期（OS）显著长于化疗。本研究的目的是从美国和中国支付方的角度，评估阿替利珠单抗与铂类化疗用于一线治疗高PD-L1表达的转移性NSCLC的成本效益。
基于IMpower110临床试验的信息构建了一个分区生存模型，以评估阿替利珠单抗与化疗作为转移性NSCLC一线治疗的成本效益。从美国和中国支付方的角度估算成本。通过进行单因素和概率敏感性分析来探讨不确定性的影响。
在美国，阿替利珠单抗治疗估计可增加0.87个质量调整生命年（QALY），成本为每QALY 123,424美元。在中国，与化疗相比，使用阿替利珠单抗的成本增加了68,489美元，增量成本效益比（ICER）为每QALY 78,936美元。敏感性分析表明，阿替利珠单抗的成本在两国都是最有影响力的因素。
在美国，每QALY的支付意愿（WTP）阈值为100,000至150,000美元，与化疗相比，阿替利珠单抗是高PD-L1表达的转移性NSCLC患者一线治疗的成本效益策略。对于中国，每QALY的WTP阈值为33,210美元，阿替利珠单抗不被认为是NSCLC的高性价比治疗方法，降价52%似乎是合理的。
