Shuxia Qin1, Lidan Yi1, Sini Li2, Chongqing Tan1, Xiaohui Zeng3, Liting Wang1, Ye Peng1, Xiaomin Wan4. 1. Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China. 2. Xiangya Nursing School, Central South University, Changsha, 410013, Hunan, China. 3. PET-CT Center, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China. 4. Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China. wanxiaomin@csu.edu.cn.
Abstract
INTRODUCTION: The IMvigor130 trial found that atezolizumab plus platinum-based chemotherapy (atezolizumab group) as first-line therapy prolonged progression-free survival (PFS) in patients with metastatic urothelial cancer (mUC), compared with placebo plus platinum-based chemotherapy (placebo group). The current study aimed to evaluate the cost-effectiveness of atezolizumab plus platinum-based chemotherapy as first-line therapy for mUC from the US payer perspective. METHODS: A Markov model was adopted to compare the cost and effectiveness of atezolizumab and placebo group in the first-line setting of patients with mUC. Life years (LYs), quality-adjusted LYs (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs) were calculated. Subgroup, one-way, and probabilistic sensitivity analyses were performed to explore the model robustness. RESULTS:Atezolizumab group provided an additional 0.39 QALYs (0.52 LYs) and an incremental cost of $170,759 per QALY compared with the placebo group. The incremental cost-effectiveness ratio was $434,317 per QALY. Subgroup analysis indicated that PD-L1 expression of at least 5% on immune cells had an incremental cost-effectiveness ratio of $325,236 per QALY. The results of one-way sensitivity analyses suggested that our model was sensitive to the cycle cost of atezolizumab and the hazard ratio of PFS. Probabilistic sensitivity analyses revealed that there was 0% probability of the atezolizumab group being cost-effective at a willingness-to-pay (WTP) threshold of $150,000 per QALY. The extrapolations need to be validated by real-world data. CONCLUSIONS: From the US payer perspective, atezolizumab plus platinum-based chemotherapy is not cost-effective in the first-line therapy for patients with mUC on the basis of a WTP threshold of $150,000 per QALY. On the basis of the value standpoint, price reduction of atezolizumab is expected to improve the cost-effectiveness of atezolizumab in patients with mUC.
RCT Entities:
INTRODUCTION: The IMvigor130 trial found that atezolizumab plusplatinum-based chemotherapy (atezolizumab group) as first-line therapy prolonged progression-free survival (PFS) in patients with metastatic urothelial cancer (mUC), compared with placebo plus platinum-based chemotherapy (placebo group). The current study aimed to evaluate the cost-effectiveness of atezolizumab plusplatinum-based chemotherapy as first-line therapy for mUC from the US payer perspective. METHODS: A Markov model was adopted to compare the cost and effectiveness of atezolizumab and placebo group in the first-line setting of patients with mUC. Life years (LYs), quality-adjusted LYs (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs) were calculated. Subgroup, one-way, and probabilistic sensitivity analyses were performed to explore the model robustness. RESULTS:Atezolizumab group provided an additional 0.39 QALYs (0.52 LYs) and an incremental cost of $170,759 per QALY compared with the placebo group. The incremental cost-effectiveness ratio was $434,317 per QALY. Subgroup analysis indicated that PD-L1 expression of at least 5% on immune cells had an incremental cost-effectiveness ratio of $325,236 per QALY. The results of one-way sensitivity analyses suggested that our model was sensitive to the cycle cost of atezolizumab and the hazard ratio of PFS. Probabilistic sensitivity analyses revealed that there was 0% probability of the atezolizumab group being cost-effective at a willingness-to-pay (WTP) threshold of $150,000 per QALY. The extrapolations need to be validated by real-world data. CONCLUSIONS: From the US payer perspective, atezolizumab plusplatinum-based chemotherapy is not cost-effective in the first-line therapy for patients with mUC on the basis of a WTP threshold of $150,000 per QALY. On the basis of the value standpoint, price reduction of atezolizumab is expected to improve the cost-effectiveness of atezolizumab in patients with mUC.