OBJECTIVES: To assess the cost-effectiveness of atezolizumab (humanised antiprogrammed death-ligand 1 [PD-L1] monoclonal antibody) compared to docetaxel in the treatment of locally advanced or metastatic non-small cell lung carcinoma (NSCLC) in previously treated PD-L1negative patients, in the Portuguese setting.

METHODS: The cost-effectiveness analysis was based on a partitioned-survival model using data from OAK, a head-to-head phase III randomized controlled trial. Utility weights were also derived from OAK and stratified according to time-to-death and off and on treatment. Portuguese-specific disease management resource use was based on a panel of clinical experts and on Portuguese DRG microdata. National legislation and official drug cost databases were the main sources for unit costs. The analysis was conducted from a payers’ perspective, assuming a lifetime horizon and a 5% discount rate for both costs and effects. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of results.

RESULTS: Atezolizumab increases average life expectancy by 0.74 undiscounted life years (LY) enabling a discounted gain of 0.58 LY or 0.44 quality adjusted life years (QALY). Economic analysis shows that the higher costs of the atezolizumab option is mainly attributed to higher treatment costs. The estimated incremental cost-effectiveness ratios (ICER) are 59,295€/LY and 78,977€/QALY. Deterministic sensitivity analyses show that results are robust to most scenarios but sensitive to treatment duration and parametric extrapolation options.

CONCLUSIONS:The cost-effectiveness model of atezolizumab in the treatment of PD-L1 negative patients with locally advanced or metastatic NSCLC after prior chemotherapy was considered valid to support a reimbursement decision in the Portuguese setting. Atezolizumab is recommended for routine use in the Portuguese National Health Service.