OBJECTIVES: Breast cancer with a triple negative phenotype (TNBC) is aggressive form of the disease. The survival at stage 4 is 1 year at most. The goal of the study was assessment of a new option for inoperable TNBC (presence of PD-L1 ≥1%): atezolizumab in combination with nab-paclitaxel.

METHODS: A decision analysis model was used followed by Markov modeling. The cost-effectiveness analysis (CEA) with incremental cost-effectiveness ratio (ICER) calculation was performed. The combination of atezolizumab+nab-paclitaxel and nab-paclitaxel monotherapy regimens were evaluated. Overall survival (OS) was taken as an effectiveness criterion. Budget impact analysis (BIA) was performed with a one-year and three-year perspective in order to assess the difference in direct costs between the current therapy practice (excluding the use of the combination under consideration) and the expected practice (taking into account the use of the combination).

RESULTS: TNBC therapy has a high cost in both combination therapy and monotherapy regimens. The use of atezolizumab plus nab-paclitaxel option increased the median OS from 15.5 to 25 months. At the same time, the total costs of using the combined regimen were €124,987 for two years, which is 2.6 times more expensive than nab-paclitaxel monotherapy. ICER for the combined regimen amounted to €8,155, which is significantly less than society willingness-to-pay threshold that equals €27,341 (triple GDP per capita). In addition, ICER value for atazodizumab+nab-paclitaxel is significantly lower than the incremental indicators for alternate therapeutic options used for other curable forms of breast cancer, e.g., trastuzumab emtansine in comparison with lapatinib+capecitabine (€272,669 for the LYG, and €329 475 for QALYs). BIA demonstrated the absence of significant impact on the level of costs for providing patients with breast cancer in general.

CONCLUSIONS: The use of atezolizumab plus nab-paclitaxel for the TNBC treatment is an economically feasible option for patients with a poor prognosis.