Skip to main content
Erschienen in: Advances in Therapy 5/2020

19.03.2020 | Original Research

Cost-Effectiveness Analysis of Atezolizumab Plus Chemotherapy in the First-Line Treatment of Metastatic Non-Squamous Non-Small Cell Lung Cancer

verfasst von: Dong Ding, Huabin Hu, Mengting Liao, Yin Shi, Longjiang She, Linli Yao, Youwen Zhu, Shan Zeng, Jin Huang

Erschienen in: Advances in Therapy | Ausgabe 5/2020

Einloggen, um Zugang zu erhalten

Abstract

Introduction

The purpose of this study was to estimate the cost-effectiveness of atezolizumab plus chemotherapy in patients with metastatic non-squamous non-small cell lung cancer (NSCLC) from the United States (US) payers’ perspective in the first-line treatment.

Methods

A mathematical Markov model was developed to estimate cost and effectiveness of atezolizumab combination therapy versus carboplatin plus nab-paclitaxel alone in the first-line therapy of metastatic non-squamous NSCLC from the data of IMpower130. Costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were analyzed, and model robustness was assessed by sensitivity analysis. Additional subgroup analyses were performed as well.

Results

Compared to chemotherapy, treatment with atezolizumab plus chemotherapy yields an increase of 0.16 QALYs with an increase in cost of $109,809.13, resulting in an ICER of $670,309.66 per QALY. The most influential factor in this model was the cost of atezolizumab. Probabilistic sensitivity analysis showed that there was 0% probability that atezolizumab plus chemotherapy was cost-effective at willingness-to-pay (WTP) values of $150,000 per QALY. The results of subgroup analyses showed that the ICER remained greater than $150,000/QALY across the all patient subgroups.

Conclusion

First-line treatment with atezolizumab in combination with carboplatin plus nab-paclitaxel is not a cost-effective option in patients with metastatic non-squamous NSCLC.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Fitzmaurice C, Akinyemiju TF, Al Lami FH, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990–2016: a systematic analysis for the global burden of disease study. JAMA Oncol. 2018;4:1553–68.CrossRef Fitzmaurice C, Akinyemiju TF, Al Lami FH, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990–2016: a systematic analysis for the global burden of disease study. JAMA Oncol. 2018;4:1553–68.CrossRef
2.
Zurück zum Zitat Bonotto M, Gerratana L, Iacono D, et al. Treatment of metastatic breast cancer in a real-world scenario: is progression-free survival with first line predictive of benefit from second and later lines? Oncologist. 2015;20:719–24.CrossRef Bonotto M, Gerratana L, Iacono D, et al. Treatment of metastatic breast cancer in a real-world scenario: is progression-free survival with first line predictive of benefit from second and later lines? Oncologist. 2015;20:719–24.CrossRef
3.
Zurück zum Zitat Herbst RS, Redman MW, Kim ES, et al. Cetuximab plus carboplatin and paclitaxel with or without bevacizumab versus carboplatin and paclitaxel with or without bevacizumab in advanced NSCLC (SWOG S0819): a randomised, phase 3 study. Lancet Oncol. 2018;19:101.CrossRef Herbst RS, Redman MW, Kim ES, et al. Cetuximab plus carboplatin and paclitaxel with or without bevacizumab versus carboplatin and paclitaxel with or without bevacizumab in advanced NSCLC (SWOG S0819): a randomised, phase 3 study. Lancet Oncol. 2018;19:101.CrossRef
4.
Zurück zum Zitat Miller KD, Nogueira L, Mariotto AB, et al. Cancer treatment and survivorship statistics. CA Cancer J Clin. 2019;69(2019):363–85.CrossRef Miller KD, Nogueira L, Mariotto AB, et al. Cancer treatment and survivorship statistics. CA Cancer J Clin. 2019;69(2019):363–85.CrossRef
5.
Zurück zum Zitat Qiao F, Li N, Li W. Integrative bioinformatics analysis reveals potential long non-coding RNA biomarkers and analysis of function in non-smoking females with lung cancer. Med Sci Monit. 2018;24:5771–8.CrossRef Qiao F, Li N, Li W. Integrative bioinformatics analysis reveals potential long non-coding RNA biomarkers and analysis of function in non-smoking females with lung cancer. Med Sci Monit. 2018;24:5771–8.CrossRef
6.
Zurück zum Zitat Zhou D, Xie M, He B, Gao Y, Chen Q. Microarray data re-annotation reveals specific lncRNAs and their potential functions in non-small cell lung cancer subtypes. Mol Med Rep. 2017;16:5129–36.CrossRef Zhou D, Xie M, He B, Gao Y, Chen Q. Microarray data re-annotation reveals specific lncRNAs and their potential functions in non-small cell lung cancer subtypes. Mol Med Rep. 2017;16:5129–36.CrossRef
7.
Zurück zum Zitat Zou T, Yin J, Zheng W, et al. Rho GTPases: RAC1 polymorphisms affected platinum-based chemotherapy toxicity in lung cancer patients. Cancer Chemother Pharmacol. 2016;78:249–58.CrossRef Zou T, Yin J, Zheng W, et al. Rho GTPases: RAC1 polymorphisms affected platinum-based chemotherapy toxicity in lung cancer patients. Cancer Chemother Pharmacol. 2016;78:249–58.CrossRef
8.
Zurück zum Zitat Planchard D, Popat S, Kerr K, et al. Metastatic non-small cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29:192–237.CrossRef Planchard D, Popat S, Kerr K, et al. Metastatic non-small cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29:192–237.CrossRef
10.
Zurück zum Zitat Rittmeyer A, Barlesi F, Waterkamp D, et al. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. Lancet. 2017;389:255–65.CrossRef Rittmeyer A, Barlesi F, Waterkamp D, et al. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. Lancet. 2017;389:255–65.CrossRef
11.
Zurück zum Zitat Socinski MA, Jotte RM, Cappuzzo F, et al. Atezolizumab for first-line treatment of metastatic nonsquamous NSCLC. N Engl J Med. 2018;378:2288–301.CrossRef Socinski MA, Jotte RM, Cappuzzo F, et al. Atezolizumab for first-line treatment of metastatic nonsquamous NSCLC. N Engl J Med. 2018;378:2288–301.CrossRef
13.
Zurück zum Zitat West H, McCleod M, Hussein M, et al. Atezolizumab in combination with carboplatin plus nab-paclitaxel chemotherapy compared with chemotherapy alone as first-line treatment for metastatic non-squamous non-small-cell lung cancer (IMpower130): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2019;20:924–37.CrossRef West H, McCleod M, Hussein M, et al. Atezolizumab in combination with carboplatin plus nab-paclitaxel chemotherapy compared with chemotherapy alone as first-line treatment for metastatic non-squamous non-small-cell lung cancer (IMpower130): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2019;20:924–37.CrossRef
14.
Zurück zum Zitat Goldstein DA, Chen Q, Ayer T, et al. First- and second-line bevacizumab in addition to chemotherapy for metastatic colorectal cancer: a United States-based cost-effectiveness analysis. J Clin Oncol. 2015;33:1112–8.CrossRef Goldstein DA, Chen Q, Ayer T, et al. First- and second-line bevacizumab in addition to chemotherapy for metastatic colorectal cancer: a United States-based cost-effectiveness analysis. J Clin Oncol. 2015;33:1112–8.CrossRef
15.
Zurück zum Zitat Hoyle MW, Henley W. Improved curve fits to summary survival data: application to economic evaluation of health technologies. BMC Med Res Methodol. 2011;11:139.CrossRef Hoyle MW, Henley W. Improved curve fits to summary survival data: application to economic evaluation of health technologies. BMC Med Res Methodol. 2011;11:139.CrossRef
16.
Zurück zum Zitat Nafees B, Lloyd AJ, Dewilde S, Rajan N, Lorenzo M. Health state utilities in non-small cell lung cancer: an international study. Asia Pac J Clin Oncol. 2017;13:e195–203.CrossRef Nafees B, Lloyd AJ, Dewilde S, Rajan N, Lorenzo M. Health state utilities in non-small cell lung cancer: an international study. Asia Pac J Clin Oncol. 2017;13:e195–203.CrossRef
17.
Zurück zum Zitat Nafees B, Stafford M, Gavriel S, Bhalla S, Watkins J. Health state utilities for non small cell lung cancer. Health Qual Life Outcomes. 2008;6:84.CrossRef Nafees B, Stafford M, Gavriel S, Bhalla S, Watkins J. Health state utilities for non small cell lung cancer. Health Qual Life Outcomes. 2008;6:84.CrossRef
18.
Zurück zum Zitat Handorf EA, McElligott S, Vachani A, et al. Cost effectiveness of personalized therapy for first-line treatment of stage IV and recurrent incurable adenocarcinoma of the lung. J Oncol Pract. 2012;8:267–74.CrossRef Handorf EA, McElligott S, Vachani A, et al. Cost effectiveness of personalized therapy for first-line treatment of stage IV and recurrent incurable adenocarcinoma of the lung. J Oncol Pract. 2012;8:267–74.CrossRef
19.
Zurück zum Zitat XiaoMin W, Zhang Y, Tan CQ, Zeng X, Peng L. First-line nivolumab plus ipilimumab vs sunitinib for metastatic renal cell carcinoma: a cost-effectiveness analysis. JAMA Oncol. 2019;5:491–6.CrossRef XiaoMin W, Zhang Y, Tan CQ, Zeng X, Peng L. First-line nivolumab plus ipilimumab vs sunitinib for metastatic renal cell carcinoma: a cost-effectiveness analysis. JAMA Oncol. 2019;5:491–6.CrossRef
22.
Zurück zum Zitat Carlson JJ, Canestaro W, Ravelo A, Wong W. The cost-effectiveness of alectinib in anaplastic lymphoma kinase-positive (ALK+) advanced NSCLC previously treated with crizotinib. J Med Econ. 2017;20:671–7.CrossRef Carlson JJ, Canestaro W, Ravelo A, Wong W. The cost-effectiveness of alectinib in anaplastic lymphoma kinase-positive (ALK+) advanced NSCLC previously treated with crizotinib. J Med Econ. 2017;20:671–7.CrossRef
23.
Zurück zum Zitat Mistry R, May JR, Suri G, et al. Cost-effectiveness of ribociclib plus letrozole versus palbociclib plus letrozole and letrozole monotherapy in the first-line treatment of postmenopausal women with HR+/HER2− advanced or metastatic breast cancer: a US payer perspective. J Manag Care Spec Pharm. 2018;24:514–23.PubMed Mistry R, May JR, Suri G, et al. Cost-effectiveness of ribociclib plus letrozole versus palbociclib plus letrozole and letrozole monotherapy in the first-line treatment of postmenopausal women with HR+/HER2− advanced or metastatic breast cancer: a US payer perspective. J Manag Care Spec Pharm. 2018;24:514–23.PubMed
24.
Zurück zum Zitat Huang M, Lou YY, Pellissier J, et al. Cost effectiveness of pembrolizumab vs. standard-of-care chemotherapy as first-line treatment for metastatic NSCLC that expresses high levels of PD-L1 in the United States. Pharmacoeconomics. 2017;35:831–44.CrossRef Huang M, Lou YY, Pellissier J, et al. Cost effectiveness of pembrolizumab vs. standard-of-care chemotherapy as first-line treatment for metastatic NSCLC that expresses high levels of PD-L1 in the United States. Pharmacoeconomics. 2017;35:831–44.CrossRef
25.
Zurück zum Zitat Ting J, Tien-Ho P, Xiang P, et al. Cost-effectiveness and value of information of erlotinib, afatinib, and cisplatin-pemetrexed for first-line treatment of advanced EGFR mutation-positive non-small-cell lung cancer in the United States. Value Health. 2015;18:774–82.CrossRef Ting J, Tien-Ho P, Xiang P, et al. Cost-effectiveness and value of information of erlotinib, afatinib, and cisplatin-pemetrexed for first-line treatment of advanced EGFR mutation-positive non-small-cell lung cancer in the United States. Value Health. 2015;18:774–82.CrossRef
26.
Zurück zum Zitat Cho SK, Hay JW, Barzi A. Cost-effectiveness analysis of regorafenib and TAS-102 in refractory metastatic colorectal cancer in the United States. Clin Colorectal Cancer. 2018;17:e751–61.CrossRef Cho SK, Hay JW, Barzi A. Cost-effectiveness analysis of regorafenib and TAS-102 in refractory metastatic colorectal cancer in the United States. Clin Colorectal Cancer. 2018;17:e751–61.CrossRef
27.
Zurück zum Zitat Goldstein DA, Ahmad BB, Chen Q, et al. Cost-effectiveness analysis of regorafenib for metastatic colorectal cancer. J Clin Oncol. 2015;33:3727–32.CrossRef Goldstein DA, Ahmad BB, Chen Q, et al. Cost-effectiveness analysis of regorafenib for metastatic colorectal cancer. J Clin Oncol. 2015;33:3727–32.CrossRef
28.
Zurück zum Zitat Zhang Y, Baik SH, Fendrick AM, Baicker K. Comparing local and regional variation in health care spending. N Engl J Med. 2012;367:1724–31.CrossRef Zhang Y, Baik SH, Fendrick AM, Baicker K. Comparing local and regional variation in health care spending. N Engl J Med. 2012;367:1724–31.CrossRef
29.
Zurück zum Zitat Wu B, Zhang Q, Sun J. Cost-effectiveness of nivolumab plus ipilimumab as first-line therapy in advanced renal-cell carcinoma. J Immunother Cancer. 2018;6:124.CrossRef Wu B, Zhang Q, Sun J. Cost-effectiveness of nivolumab plus ipilimumab as first-line therapy in advanced renal-cell carcinoma. J Immunother Cancer. 2018;6:124.CrossRef
30.
Zurück zum Zitat Hoyle M, Green C, Thompson-Coon J, et al. Cost-effectiveness of temsirolimus for first line treatment of advanced renal cell carcinoma. Value Health. 2010;13:61–8.CrossRef Hoyle M, Green C, Thompson-Coon J, et al. Cost-effectiveness of temsirolimus for first line treatment of advanced renal cell carcinoma. Value Health. 2010;13:61–8.CrossRef
31.
Zurück zum Zitat Redman JM, Gibney GT, Atkins MB. Advances in immunotherapy for melanoma. BMC Med. 2016;14:20.CrossRef Redman JM, Gibney GT, Atkins MB. Advances in immunotherapy for melanoma. BMC Med. 2016;14:20.CrossRef
32.
Zurück zum Zitat Emens LA, Ascierto PA, Darcy PK, et al. Cancer immunotherapy: opportunities and challenges in the rapidly evolving clinical landscape. Eur J Cancer. 2017;81:116–29.CrossRef Emens LA, Ascierto PA, Darcy PK, et al. Cancer immunotherapy: opportunities and challenges in the rapidly evolving clinical landscape. Eur J Cancer. 2017;81:116–29.CrossRef
33.
Zurück zum Zitat Robert C, Schachter J, Long GV, et al. Pembrolizumab versus ipilimumab in advanced melanoma. N Engl J Med. 2015;372:2521–32.CrossRef Robert C, Schachter J, Long GV, et al. Pembrolizumab versus ipilimumab in advanced melanoma. N Engl J Med. 2015;372:2521–32.CrossRef
34.
Zurück zum Zitat Long GV, Atkinson V, Cebon JS, et al. Standard-dose pembrolizumab in combination with reduced-dose ipilimumab for patients with advanced melanoma (KEYNOTE-029): an open-label, phase 1b trial. Lancet Oncol. 2017;18:1202–10.CrossRef Long GV, Atkinson V, Cebon JS, et al. Standard-dose pembrolizumab in combination with reduced-dose ipilimumab for patients with advanced melanoma (KEYNOTE-029): an open-label, phase 1b trial. Lancet Oncol. 2017;18:1202–10.CrossRef
35.
Zurück zum Zitat Criss SD, Mooradian MJ, Watson TR, et al. Cost-effectiveness of atezolizumab combination therapy for first-line treatment of metastatic nonsquamous non-small cell lung cancer in the United States. JAMA Netw Open. 2019;2:e1911952.CrossRef Criss SD, Mooradian MJ, Watson TR, et al. Cost-effectiveness of atezolizumab combination therapy for first-line treatment of metastatic nonsquamous non-small cell lung cancer in the United States. JAMA Netw Open. 2019;2:e1911952.CrossRef
36.
Zurück zum Zitat Wan X, Luo X, Tan C, et al. First-line atezolizumab in addition to bevacizumab plus chemotherapy for metastatic, nonsquamous non-small cell lung cancer: a United States-based cost-effectiveness analysis. Cancer. 2019;125:3526–34.CrossRef Wan X, Luo X, Tan C, et al. First-line atezolizumab in addition to bevacizumab plus chemotherapy for metastatic, nonsquamous non-small cell lung cancer: a United States-based cost-effectiveness analysis. Cancer. 2019;125:3526–34.CrossRef
37.
Zurück zum Zitat Georgieva M, Lima JPDN, Aguiar P, Lopes GD, Haaland B. Cost-effectiveness of pembrolizumab as first-line therapy for advanced non-small cell lung cancer. Lung Cancer. 2018;124:248–54.CrossRef Georgieva M, Lima JPDN, Aguiar P, Lopes GD, Haaland B. Cost-effectiveness of pembrolizumab as first-line therapy for advanced non-small cell lung cancer. Lung Cancer. 2018;124:248–54.CrossRef
38.
Zurück zum Zitat She Longjiang, Huabin Hu, Liao Mengting, et al. Cost-effectiveness analysis of pembrolizumab versus chemotherapy as first-line treatment in locally advanced or metastatic non-small cell lung cancer with PD-L1 tumor proportion score 1% or greater. Lung cancer. 2019;138:88–94.CrossRef She Longjiang, Huabin Hu, Liao Mengting, et al. Cost-effectiveness analysis of pembrolizumab versus chemotherapy as first-line treatment in locally advanced or metastatic non-small cell lung cancer with PD-L1 tumor proportion score 1% or greater. Lung cancer. 2019;138:88–94.CrossRef
39.
Zurück zum Zitat Insinga RP, Vanness DJ, Feliciano JL, et al. Cost-effectiveness of pembrolizumab in combination with chemotherapy in the 1st line treatment of non-squamous NSCLC in the US. J Med Econ. 2018;21:1191–205.CrossRef Insinga RP, Vanness DJ, Feliciano JL, et al. Cost-effectiveness of pembrolizumab in combination with chemotherapy in the 1st line treatment of non-squamous NSCLC in the US. J Med Econ. 2018;21:1191–205.CrossRef
Metadaten
Titel
Cost-Effectiveness Analysis of Atezolizumab Plus Chemotherapy in the First-Line Treatment of Metastatic Non-Squamous Non-Small Cell Lung Cancer
verfasst von
Dong Ding
Huabin Hu
Mengting Liao
Yin Shi
Longjiang She
Linli Yao
Youwen Zhu
Shan Zeng
Jin Huang
Publikationsdatum
19.03.2020
Verlag
Springer Healthcare
Erschienen in
Advances in Therapy / Ausgabe 5/2020
Print ISSN: 0741-238X
Elektronische ISSN: 1865-8652
DOI
https://doi.org/10.1007/s12325-020-01292-3

Weitere Artikel der Ausgabe 5/2020

Advances in Therapy 5/2020 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

15% bedauern gewählte Blasenkrebs-Therapie

29.05.2024 Urothelkarzinom Nachrichten

Ob Patienten und Patientinnen mit neu diagnostiziertem Blasenkrebs ein Jahr später Bedauern über die Therapieentscheidung empfinden, wird einer Studie aus England zufolge von der Radikalität und dem Erfolg des Eingriffs beeinflusst.

Costims – das nächste heiße Ding in der Krebstherapie?

28.05.2024 Onkologische Immuntherapie Nachrichten

„Kalte“ Tumoren werden heiß – CD28-kostimulatorische Antikörper sollen dies ermöglichen. Am besten könnten diese in Kombination mit BiTEs und Checkpointhemmern wirken. Erste klinische Studien laufen bereits.

Perioperative Checkpointhemmer-Therapie verbessert NSCLC-Prognose

28.05.2024 NSCLC Nachrichten

Eine perioperative Therapie mit Nivolumab reduziert das Risiko für Rezidive und Todesfälle bei operablem NSCLC im Vergleich zu einer alleinigen neoadjuvanten Chemotherapie um über 40%. Darauf deuten die Resultate der Phase-3-Studie CheckMate 77T.

Positiver FIT: Die Ursache liegt nicht immer im Dickdarm

27.05.2024 Blut im Stuhl Nachrichten

Immunchemischer Stuhltest positiv, Koloskopie negativ – in solchen Fällen kann die Blutungsquelle auch weiter proximal sitzen. Ein Forschungsteam hat nachgesehen, wie häufig und in welchen Lokalisationen das der Fall ist.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.