Cost-Effectiveness Analysis of Atezolizumab Plus Chemotherapy for Treatment-Naive Patients of Extensive-Stage Small Cell Lung Cancer without Brain Metastasis
Moderator
Yi-Wen Tsai, PhD, National Yang Ming Chiao Tung University, Taipei, Taiwan
Speakers
Hsiao Ling Chen, BS, MS, Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan; Chen-Han Chueh, PhD, University of California San Diego, San Diego, CA, United States; Wei-ming Huang, PharmD, MD; Shu-Hua Chan, MSc, National Yang Ming Chiao Tung University, Da’an Dist., Taipei City, Taiwan; Hsiao-Hsiang Cheng; Shao-Chin Chiang; Chiao-En Wu; Yu-Wen Wen, PhD
OBJECTIVES: Previous cost-effectiveness analyses have found that adding atezolizumab to first-line chemotherapy is not cost-effective for all patients with extensive-stage small cell lung cancer (EX-SCLC), overlooking the significant treatment benefit for those without brain metastases (BM) in the IMpower133 trial.This study evaluated the cost-effectiveness of adding atezolizumab to chemotherapy for patients with EX-SCLC without BMs from Taiwan's National Health Insurance (NHI) perspective.
METHODS: A semi-Markov model was designed over 15 years and incorporated four health states: progression-free, progressed disease (PD) without BM, PD with BM, and death. Individual patient data from the IMpower133 trial were used to estimate the heterogeneous and time-varying efficacy, utility, and disutility parameters. Three nationwide databases were used to identify the target population and estimate direct medical cost parameters. The primary outcomes were the incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (INMB). A willingness-to-pay threshold of NT$3,023,055 (three times the 2023 gross domestic product per capita) and a 3% discount rate for both quality-adjusted life-years (QALYs) and costs were applied. Scenario analyses explored the cost-effectiveness requirements, and deterministic and probabilistic sensitivity analyses assessed the uncertainty.
RESULTS: The addition of atezolizumab to chemotherapy resulted in a gain of 0.721 QALYs at an incremental cost of NT$2,111,359, yielding an ICER of NT$2,928,376 per QALY, INMB of NT$68,624, and a 53.0% probability of cost-effectiveness. The key sources of uncertainty include efficacy parameters, time horizon, and utility estimates.
CONCLUSIONS: The addition of atezolizumab to chemotherapy is cost-effective for patients with EX-SCLC without BM under Taiwan's NHI. These findings underscore the importance of policy decisions in considering BM status in cost-effectiveness evaluations for tailored treatment decisions.
METHODS: A semi-Markov model was designed over 15 years and incorporated four health states: progression-free, progressed disease (PD) without BM, PD with BM, and death. Individual patient data from the IMpower133 trial were used to estimate the heterogeneous and time-varying efficacy, utility, and disutility parameters. Three nationwide databases were used to identify the target population and estimate direct medical cost parameters. The primary outcomes were the incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (INMB). A willingness-to-pay threshold of NT$3,023,055 (three times the 2023 gross domestic product per capita) and a 3% discount rate for both quality-adjusted life-years (QALYs) and costs were applied. Scenario analyses explored the cost-effectiveness requirements, and deterministic and probabilistic sensitivity analyses assessed the uncertainty.
RESULTS: The addition of atezolizumab to chemotherapy resulted in a gain of 0.721 QALYs at an incremental cost of NT$2,111,359, yielding an ICER of NT$2,928,376 per QALY, INMB of NT$68,624, and a 53.0% probability of cost-effectiveness. The key sources of uncertainty include efficacy parameters, time horizon, and utility estimates.
CONCLUSIONS: The addition of atezolizumab to chemotherapy is cost-effective for patients with EX-SCLC without BM under Taiwan's NHI. These findings underscore the importance of policy decisions in considering BM status in cost-effectiveness evaluations for tailored treatment decisions.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE40
Topic
Economic Evaluation
Disease
SDC: Oncology