OBJECTIVES : Lung cancer is the second most common cancer and the leading cause of cancer death worldwide. Atezolizumab as monotherapy was approved by EMA in April 2021 for the first line treatment of adult patients with metastatic non-small cell lung cancer (mNSCLC) whose tumors have PD-L1 expression ≥ 50% and who do not have EGFR mutant or ALK-positive NSCLC. The objective of this analysis is to estimate the potential budget impact of atezolizumab over a three-year time horizon from the National Healthcare Service (NHS) perspective in Italy.

METHODS : A budget impact model is adapted to the Italian context to evaluate the financial consequences of the adoption of atezolizumab as an alternative option to pembrolizumab for first line treatment of mNSCLC expressing PD-L1 ≥ 50%. The model estimates the expected healthcare costs by comparing a scenario “with atezolizumab” with a counterfactual situation “without atezolizumab”. Direct healthcare costs consist of the cost of drugs, including administration costs, adverse events management and supportive care derived from official Italian sources. Epidemiological, clinical and resource consumption data are obtained from published literature, clinical trials and local guideline documents.

RESULTS : Among 4,363 patients expected annually with mNSCLC with a PD-L1 ≥ 50%, 3,883 are considered eligible to receive a first line treatment in the initial year. Following launch, the annual budget impact is estimated to be -€ 10.5 M, -€18.4 M -€20.7 M in the first, second and third years, respectively. The results of the analysis show an incremental saving for the Italian NHS, mainly due to the reduction of the market share of pembrolizumab in favor of atezolizumab.

CONCLUSIONS : The use of atezolizumab monotherapy for first-line treatment of patients with mNSCLC and PD-L1 expression ≥ 50% is a cost saving alternative from the NHS perspective in Italy whilst providing an efficacious treatment option for patients.