The Role of Adjuvant Atezolizumab in Reducing Recurrence-Related Treatment Costs in Resected Early-Stage PD-L1 High Non-Small Cell Lung Cancer across Europe

OBJECTIVES: Loco-regional or metastatic disease recurrence in non-small cell lung cancer (NSCLC) remains common and typically entails substantial health care resource use and a high associated economic burden. The aim of this study was to estimate the recurrence-related reduction in treatment costs in patients with resected early stage NSCLC following the introduction of adjuvant atezolizumab (ATZ) in Germany, Spain, France Italy and the UK, together referred to as EU5.

METHODS: Using a previously developed epidemiological model, we estimated the reduction in loco-regional recurrences or distant metastases after adjuvant ATZ treatment following chemotherapy in resected NSCLC patients with PDL-1 expression of ≥ 50% on tumor cells (PD-L1 high), stage II-IIIA (AJCC 7th edition staging), without EGFR or ALK alterations, relative to best supportive care (BSC), defined as adjuvant platinum-based chemotherapy only. Reductions in treatment costs are estimated as the per patient cost of treating recurrent and metastatic NSCLC, using clinical evidence and expert opinion on the treatments that patients would receive after experiencing recurrence in every country. The analysis assumes that patients who experience recurrence realize these costs, and subsequently estimates the costs that would be averted in the presence and absence of adjuvant ATZ over a 10-year period (2022-2032).

RESULTS: According to our model, the estimates show that for the period between 2023-2033, a total of 4,665 recurrences would be avoided, assuming a market share of adjuvant ATZ of 75% and best supportive care of 25%. The averted cost of recurrent or metastatic NSCLC in France (€48m), Germany (€50m), Italy (€53m), Spain (€24m) and the UK (£38m) would be considerable.

CONCLUSIONS: Adjuvant ATZ following chemotherapy results in a considerable population-level reduction of recurrences in resected stage II-IIIA PD-L1 high NSCLC patients without EGFR or ALK alterations. This translates to a substantial decrease in the economic burden of the disease.