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First-Line Atezolizumab Plus Chemotherapy Not Cost-Effective for SCLC
A recent cost-effective analysis of first-line treatments for extensive-stage small-cell lung cancer (SCLC) suggests that atezolizumab plus chemotherapy is not cost-effective for SCLC in the US (Front Public Health. 2021; 9:650392. doi:10.3389/fpubh.2021.650392).
Yingcheng Wang, MD, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China, and colleagues compared atezolizumab plus chemotherapy vs chemotherapy, first-line treatments for extensive-stage cancer SCLC, aiming to determine which is more cost-effective.
A three health states partitioned survival model was created and used over a lifetime horizon. The IMpower133 trial was used to provide data on effectiveness and safety, while Medicare and Medicaid files were used to estimate costs.
In order to examine the long-term uncertainty of the effect of immunotherapy, the parametric survival model and mixture cure model were used for the atezolizumab plus chemotherapy cohort. The parametric survival model was used to evaluate the chemotherapy cohort.
The mixture cure model revealed that atezolizumab plus chemotherapy yielded an additional 0.11 quality-adjusted life-years (QALYs), with an incremental cost of $84,257, and an incremental cost-utility ratio (ICUR) of $785,848 per QALY, compared with chemotherapy alone.
The parametric survival model revealed that atezolizumab plus chemotherapy yielded an additional 0.10 QALYs, with an incremental cost of $84,257, and an ICUR of $827,610 per QALY.
When the mixture cure model and parametric model were used, the results of the scenario analysis revealed that the ICUR was $910,557 per QALY for atezolizumab plus chemotherapy and $965,607 per QALY for chemotherapy alone.
Results from the probabilistic sensitivity analysis revealed that atezolizumab plus chemotherapy was not cost-effective at a willingness-to-pay threshold of $100,000 per QALY.
“The findings of the present analysis suggest that atezolizumab plus chemotherapy is not cost-effective in patients receiving first-line treatment for extensive-stage SCLC in the US,” Dr Wang and colleagues concluded.—Marta Rybczynski
