OBJECTIVES: Lung cancer poses a high disease and economic burden on healthcare systems globally. Non-Small Cell Lung Cancer (NSCLC) accounts for approximately 85% of all lung cancer cases. Atezolizumab antibody provides inhibitory signals to PD-L1 in order to restore T cells activity. Through the immune checkpoint inhibition Atezolizumab stimulates an anti-tumour response in NSCLC patients. The objective of this analysis was to perform a cost-effectiveness analysis of Atezolizumab versus the standard of care for the treatment of adult patients with locally advanced or metastatic NSCLC after prior chemotherapy, in Greece.

METHODS: A three state partitioned survival model was developed for the cost-effectiveness analysis of Atezolizumab vs Docetaxel, Nivolumab and Pembrolizumab. The model was populated with clinical effectiveness data from the literature. Greek-specific data on real-world resource use was sourced from an expert panel of 10 oncologists. Hospital prices were used for all drugs. The analysis followed a third party payer perspective.

RESULTS: Atezolizumab offers incremental gains compared to Docetaxel (0.84 LY and 0.59 QALYs), Nivolumab (0.06 LY and 0.01 QALYs) and Pembrolizumab (0.09 LY and 0.06 QALYs). Additional total costs of €43,465 and €810 are introduced with Atezolizumab compared to Docetaxel and Pembrolizumab, whereas a reduction of €11,924 in total costs compared to Nivolumab. Atezolizumab can be considered as a cost-effective (dominant) option for the treatment of NSCLC compared to NIvolumab, and results in an ICER of 51,744/LY gained and 73,669/QALY gained compared to Docetaxel and an ICER of 9,000/LY gained and 13,500/QALY gained compared to Pembrolizumab.

CONCLUSIONS: The results of the analysis suggest that the use of anti-PD-L1 Atezolizumab, as 2^nd line treatment of NSCLC patients, offers gains in LY and QALY’s compared to existing treatment options. Atezolizumab provides health gains either at a lower cost (vs Nivolumab) or at an added cost below the acceptable threshold (vs Docetaxel and Pembrolizumab).