Amaris, Health Economics and Market Access, Paris, France.
Amaris, Health Economics and Market Access, Paris, France.
Lung Cancer. 2023 Oct;184:107316. doi: 10.1016/j.lungcan.2023.107316. Epub 2023 Jul 26.
The objective of this study was to assess the cost-effectiveness of atezolizumab versus best supportive care (BSC) as adjuvant treatment following resection and platinum-based chemotherapy for patients with stage II-IIIA non-small cell lung cancer (NSCLC) whose tumours have a programmed death-ligand 1 (PD-L1) expression ≥ 50% of tumour cells and excluding those with ALK/EGFR mutations, from a French collective perspective.
A five state Markov model over a 20-year time horizon was considered, including disease-free survival (DFS) from IMpower010 trial, three progression states (locoregional recurrence, first and second-line metastatic recurrence) and death. Utilities, quality-adjusted life year (QALY) decrements associated to adverse events, costs, resource use, and transition probabilities were considered in the model. These inputs were sourced from IMpower010 trial, literature, and clinical experts' opinion. Model uncertainty was assessed through deterministic, probabilistic sensitivity analyses and scenario analyses.
Atezolizumab was associated with a QALY gain of 1.662, mainly driven by additional time spent in the DFS state, and a life-year gain of 2.112 years. The incremental cost-effectiveness ratio (ICER) for atezolizumab versus BSC was €21,348/QALY gained. The sensitivity analyses highlighted that uncertainty within the model had limited impact on results. Changing the DFS survival curves to other plausible distributions produced ICERs below €20,000/QALY. Introducing an increasing proportion of cured patients (91.5%) from year two to year five reduced the ICER to €13,083/QALY, while including a loss of efficacy at year two in the atezolizumab treatment arm increased the ICER to €33,755/QALY.
Atezolizumab as adjuvant treatment in stage II-IIIA NSCLC resected patients with PDL1 ≥ 50% and without ALK/EGFR mutations has a lower ICER than other oncology drugs in France and a similar ICER to other adjuvant treatment in oncology.
本研究旨在从法国集体角度评估阿特珠单抗对比最佳支持治疗（BSC）作为 PD-L1 表达≥50%的 II-IIIA 期非小细胞肺癌（NSCLC）患者手术后含铂化疗的辅助治疗的成本效益，这些患者无 ALK/EGFR 突变，且排除了那些具有 ALK/EGFR 突变的患者。
我们考虑了一个 20 年时间范围内的五状态 Markov 模型，包括 IMpower010 试验中的无病生存期（DFS）、三种进展状态（局部区域复发、一线和二线转移性复发）和死亡。模型中考虑了效用、与不良事件相关的质量调整生命年（QALY）损失、成本、资源利用和转移概率。这些输入来自 IMpower010 试验、文献和临床专家的意见。通过确定性、概率敏感性分析和情景分析评估模型不确定性。
阿特珠单抗与 1.662 个 QALY 增益相关，主要是由于 DFS 状态下额外的时间增加，以及 2.112 年的生命年增益。阿特珠单抗与 BSC 相比的增量成本效益比（ICER）为 21348 欧元/QALY。敏感性分析表明，模型中的不确定性对结果的影响有限。将 DFS 生存曲线更改为其他可能的分布会产生低于 20000 欧元/QALY 的 ICER。从第二年到第五年，引入更多的治愈患者（91.5%）会将 ICER 降低至 13083 欧元/QALY，而在阿特珠单抗治疗组中第二年的疗效丧失会将 ICER 增加至 33755 欧元/QALY。
在 PD-L1≥50%且无 ALK/EGFR 突变的 II-IIIA 期 NSCLC 切除患者中，阿特珠单抗作为辅助治疗，其 ICER 低于法国其他肿瘤药物，与肿瘤学中的其他辅助治疗具有相似的 ICER。
