A Cost-Effectiveness Analysis of Atezolizumab as Adjuvant Treatment (Monotherapy) for Adult Patients With Non-Small Cell Lung Cancer Following Resection and Platinum-Based Chemotherapy in Greece

OBJECTIVES: The study aims to evaluate the cost-effectiveness of atezolizumab as adjuvant treatment (monotherapy) compared to the best supportive care (BSC), for adult patients with non−small cell lung cancer (NSCLC) with a high risk of recurrence whose tumors have PD-L1 expression on ≥ 50% of tumor cells (TC) without epidermal growth factor receptor (EGFR) mutant or anaplastic lymphoma kinase (ALK)-positive NSCLC.

METHODS: A Markov model was developed to assess the cost-effectiveness of atezolizumab versus BSC in early stage (stage II–IIIA), PD-L1 ≥ 50% NSCLC patients without EGFR mutant or ALK-positive NSCLC in Greece. The model utilized data from the IMpower010 study for disease-free survival, treatment duration, and clinical parameters. Data from metastatic studies (IMpower150/110) and existing literature was used for later disease stages. Utility, resource use, and cost inputs were obtained from metastatic studies, literature, and clinical guidelines. The analysis was conducted from the perspective of the third-party payer, considered a lifetime time horizon and a discount rate of 3.5% was applied to costs and outcomes.

RESULTS: The cost-effectiveness analysis demonstrated that treatment with atezolizumab for early stage, PD-L1 ≥ 50% NSCLC patients, without EGFR mutant or ALK-positive NSCLC, yielded significant clinical benefits. Patients receiving atezolizumab gained 1.887 quality-adjusted life years (QALYs) and 2.542 life years compared to those receiving BSC. Despite higher treatment costs (€40,988 more expensive), the incremental cost-effectiveness ratio (ICER) was estimated at €21,719 per QALY gained, indicating a reasonable value for the additional clinical benefits. Scenario analysis confirmed the robustness of the main results.

CONCLUSIONS: Atezolizumab is a cost-effective intervention in Greece for this specific patient population. Increased QALYs and life years highlight the potential long-term benefits of atezolizumab as an adjuvant treatment option. The ICER falls within accepted thresholds, supporting the economic viability of atezolizumab compared to best supportive care.