OBJECTIVES: Lung cancer is the 2^nd most common cancer for men and the 3^rd for women with 46 363 new cases in France in 2018. Non-small-cell lung cancer (NSCLC) is the predominant subtype. Atezolizumab (Tecentriq^®) as monotherapy received a favorable opinion by the Transparency Commission in October 2021 for the 1st line treatment of metastatic NSCLC whose tumours have a PD-L1 expression ≥ 50% tumour cells or ≥ 10% tumour-infiltrating immune cells and who do not have EGFR mutant or ALK-positive NSCLC. The objective of this analysis is to estimate the budget impact of the introduction of atezolizumab in this indication from the French payer perspective.

METHODS: A 3-year model was developed to compare worlds with and without atezolizumab considering both first- and second-line treatment options. Comparators were pembrolizumab and all other regimens recommended in France. The target population was estimated from the data in the Transparency Commission's opinion. Population’s characteristics and clinical data were obtained from clinical trials of atezolizumab and its comparators. Drugs’ acquisition, drugs’ administration, disease management and end of life costs were considered.

RESULTS: Over the three-year horizon and at a list price of 3,496.101 € excluding VAT, for a cumulated number of 18,300 patients in 1st line, the availability of atezolizumab in the new indication would result in a decrease in total expenditure for the French National Health Insurance estimated at 74,486,446 € (with an annual incremental cost of 16,446,339 €, 25,773,611 € and 32,266,497€ for years 1 to 3 respectively). This budgetary impact corresponds to a decrease of approximately 4.35% of current Health Insurance expenditure in this indication due to lower drug acquisition costs.

CONCLUSIONS: In addition to the direct benefit linked to the efficacy of atezolizumab in terms of overall survival, this therapeutic option allows savings for French Health Insurance expenditures.