Cost-effectiveness of adjuvant atezolizumab for patients with stage II-IIIA PD-L1+non-small-cell lung cancer

Tweetable abstractAtezolizumab is cost-effective as adjuvant treatment after resection and platinum-based chemotherapy for adults with stage II-IIIA NSCLC whose tumors have PD-L1 expression on >= 1% of tumor cells, with an ICER of $46,859/QALY, well below a willingness-to-pay threshold of $150,000/QALY. Aim: Atezolizumab improved disease-free survival (DFS) versus best supportive care (BSC) as adjuvant treatment following resection and platinum-based chemotherapy for stage II-IIIA PD-L1+ NSCLC in IMpower010. Materials & methods: This cost-effectiveness study evaluated atezolizumab versus BSC (US commercial payer perspective) using a Markov model with DFS, locoregional recurrence, first- and second-line metastatic recurrence and death health states, and a lifetime time horizon with 3% annual discounting. Results: Atezolizumab provided 1.045 additional quality-adjusted life-years (QALY) at an incremental cost of $48,956, yielding an incremental cost-effectiveness ratio of $46,859/QALY. Scenario analysis showed similar findings in a Medicare population ($48,512/QALY). Conclusion: At a willingness-to-pay threshold of $150,000/QALY and an incremental cost-effectiveness ratio of $46,859/QALY, atezolizumab is cost-effective versus BSC for adjuvant NSCLC treatment. Plain language summaryAtezolizumab treatment is 'cost-effective' for people in the USA with stage II-IIIA PD-L1+ non-small-cell lung cancer after surgery and chemotherapy. Until recently, people whose doctors told them they have stage II-IIIA non-small-cell lung cancer with PD-L1 expression on >= 1% of tumor cells (known as 'PD-L1+') did not have many treatment options beyond chemotherapy after surgery. Their cancer often returns even after chemotherapy. One treatment called atezolizumab showed good survival results in clinical trials and is approved in the USA for treatment after the lung tumor has been removed in surgery. Understanding how better survival and quality of life is related to the costs of treatment (known as 'cost-effectiveness') is important. For example, insurance companies in the USA may use this information to decide what cancer drugs are preferred for insurance coverage. This study found that atezolizumab treatment was 'cost-effective' for people in the USA with stage II-IIIA PD-L1+ non-small-cell lung cancer when it was given after surgery and chemotherapy.