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

OBJECTIVES: Investment in treating early non-small cell lung cancer (eNSCLC) may have substantial long-term benefits for patients and healthcare systems by potentially preventing disease recurrence. The aim of this study is to estimate the reduction in recurrences and downstream treatment cost savings in patients with resected eNSCLC in Belgium, following the introduction of adjuvant atezolizumab (ATZ).

METHODS: Using an epidemiological model, we estimated the decrease in both loco-regional and metastatic recurrences in patients with operable eNSCLC (stage II-IIIA, AJCC 7th edition staging) with PD-L1 expression of ≥ 50% on tumor cells, without EGFR or ALK alterations, following treatment with chemotherapy and adjuvant ATZ. Data from the Belgian cancer registry, published literature, and market research was used to obtain incidence rates, staging distribution, biomarker status data, and adjuvant treatment rates. Disease-free survival (DFS) of patients treated with adjuvant ATZ was obtained from the IMpower010 (NCT02486718) trial and was used to calculate the projected reduction in the number of recurrences over a 10-year period post-ATZ launch (2025-2034) relative to best supportive care (BSC). To estimate reductions in treatment costs, per patient cost of managing recurrent and metastatic NSCLC were considered, using clinical evidence and expert opinions on the treatments typically administered to patients experiencing recurrence.

RESULTS: Assuming a market share of adjuvant ATZ of 65% and best supportive care of 35%, a total of 69 loco-regional and 84 distant recurrences could be avoided in Belgium, over the period 2025-2034. This corresponds to a 25% reduction in recurrences, translating into 8 million Euros in averted treatment costs.

CONCLUSIONS: Treatment with adjuvant ATZ after chemotherapy leads to a notable decrease in recurrences in eligible eNSCLC patients and associated treatment costs.