OBJECTIVES: To evaluate the cost-effectiveness of atezolizumab versus docetaxel in patients with previously treated locally advanced or metastatic non-small cell lung cancer (NSCLC) in Belgium.

METHODS: A partitioned survival model including the health states on-treatment/pre-progression, off-treatment/post-progression and death was developed to estimate lifetime costs and benefits of atezolizumab versus docetaxel. Parametric functions were fitted to the phase III OAK trial data regarding time to discontinuation (TTD), progression-free survival (PFS) and overall survival (OS). A mixture-cure model with 0% cure was applied for OS to account for the long survival tail with atezolizumab. Treatment-related costs were determined by TTD; disease-related costs by PFS (docetaxel) or TTD (atezolizumab). Health state utilities were sourced from the OAK trial (EQ-5D-3L data) using UK preference scores and accounting for treatment and proximity to death. Costs (2017) were calculated from resource use based on expert opinion analysis or obtained from literature. The public health care payer perspective was considered. Costs and outcomes were discounted at 3% and 1.5% respectively. Sensitivity and scenario analyses were performed.

RESULTS: Compared to docetaxel, atezolizumab was associated with a gain of 0.980 (2.190 versus 1.210) life years (LYs) and 0.723 (1.457 versus 0.734) quality-adjusted life years (QALYs) and an incremental cost of €86,942 driven by treatment costs and prolonged life expectancy. The incremental cost-effectiveness ratio was €88,753/LY; the incremental cost-utility ratio (ICUR) €120,283/QALY. In the one-way sensitivity analysis, the ICUR ranged between €103,795/QALY and €135,944/QALY. The modelled OS distribution was the most influential setting in the scenario analyses.

CONCLUSIONS: Atezolizumab provides substantial improvements over docetaxel in outcomes of patients with previously treated locally advanced or metastatic NSCLC and is associated with an estimated cost per QALY of €120,283.