For treating patients with non-small cell lung cancer, greater relative use of atezolizumab vs pembrolizumab was associated with a lower cancer immunotherapy (CIT) budget impact, according to findings presented at AMCP 2023.

Atezolizumab is indicated for the treatment of stages 2 through 3A NSCLC after patients have undergone resection and platinum-based chemotherapy. Pembrolizumab has not yet been approved for this patient population, so researchers sought to investigate this agent’s potential impact on treatment costs. 

“This study evaluated the budget impact of maintaining atezolizumab at current market share for [early NSCLC] vs decreasing its market share due to pembrolizumab use in a hypothetical US health plan,” researchers said.

Researchers created a budget impact model with a 1-year time horizon, representing 1 million patients enrolled in Medicare or commercial plans. The model accounted for the costs of each drug according to wholesale acquisition cost or average sales price, adverse event management, and treatment administration. 

“The total annual cost and per-member per-month (PMPM) costs were estimated for current (without pembrolizumab) and potential future market scenarios, where atezolizumab is assumed to split the projected CIT market share with pembrolizumab (Scenario 1) or pembrolizumab takes the entire CIT market share (Scenario 2),” researchers said.

For every 1 million commercial members, 22 patients would be eligible for treatment with atezolizumab, according to the findings. Compared to scenarios 1 and 2, maintaining atezolizumab at entire market share was associated with cost savings of $36,974 (-$0.003 PMPM) or $194,599 (-$0.016 PMPM), respectively.

As for Medicare, approximately 115 per 1 million members would be eligible for adjuvant therapy. Maintaining atezolizumab yielded cost savings of $220,028 (-$0.018 PMPM) or $1,158,043 (-$0.097 PMPM) when pembrolizumab assumed partial or entire market share, respectively.

If pembrolizumab were to expand to the entire CIT market share due to a broader label, maintaining atezolizumab’s current market share would yield cost savings of $250,772 (-$0.021 PMPM) for commercial plans and $1,344,359 (-$0.112 PMPM) for Medicare plans, findings showed.

“The budget impact of CIT in the adjuvant [early NSCLC] setting decreases with greater relative use of atezolizumab vs pembrolizumab from both US commercial and Medicare payer perspectives,” researchers concluded.

Genentech sponsored the study.

Reference:
Lee J, Maignan K, Cobden D, Ogale S. Budget impact of maintaining atezolizumab as a preferred treatment option for adjuvant treatment of patients with early non-small cell lung cancer. J Manag Care Spec Pharm. 2023;29(10-a suppl):S1-S137. https://www.jmcp.org/pb-assets/Poster%20Abstract%20Supplements/AMCP2023_PosterAbstractSupplement_0317-1679318682267.pdf