Presentation (CTI)

OBJECTIVES: Both Atezolizumab and pembrolizumab have demonstrated improved disease-free survival (DFS) and overall survival (OS) in early-stage NSCLC in the adjuvant setting. However, cost-effectiveness analyses of these novel immunotherapies in Asian countries are limited, especially within Taiwan's healthcare context. This study aims to evaluate the cost-effectiveness of atezolizumab or pembrolizumab combined with adjuvant chemotherapy only in patients with stage II-IIIA NSCLC and PD-L1 tumor cell expression (TC) ≥ 1% from the perspective of Taiwan’s National Health Insurance (NHI).
METHODS: An eight-state Markov model was constructed, incorporating disease-free survival (DFS), locoregional recurrence managed with curative treatment, palliative treatment, or no treatment; first-line metastatic recurrence treated curatively, palliatively, or not at all; second-line metastatic recurrence managed with curative treatment, palliative treatment, or no treatment; and death. The base case model adopts a lifetime horizon (40 years) and 3% annual discounting. Efficacy parameters were derived from IMpower010 and KEYNOTE091 clinical trial data, integrating through network meta-analysis. Taiwan-specific costs, utilities, and $101,949/QALY (three times Taiwan’s per capita GDP in 2024) willingness-to-pay threshold were applied. Sensitivity and scenario analyses assessed uncertainty around assumptions and parameter estimates to evaluate the robustness of the model.
RESULTS: Base case analysis showed that atezolizumab and pembrolizumab compared to best supportive care (BSC), yielded ICERs of $72,075/QALY and $55,322/QALY, respectively. Moreover, comparing pembrolizumab with atezolizumab treatment, the ICER was $26,361 /QALY. Sensitivity analyses, consistent with the base case results, demonstrated that utility parameters in the DFS and cost of pembrolizumab predominantly had the most substantial impacts on the overall outcomes.
CONCLUSIONS: In Taiwan, administering atezolizumab or pembrolizumab following adjuvant chemotherapy shows cost-effectiveness for patients with stage II-IIIA NSCLC and PD-L1 TC ≥ 1%, based on a WTP threshold of $101,949 (three times Taiwan’s per capita GDP in 2024) per QALY.