Cost-Effectiveness of Atezolizumab Plus Chemotherapy as First-Line Therapy for Metastatic Urothelial Cancer

Shuxia Qin; Lidan Yi; Sini Li; Chongqing Tan; Xiaohui Zeng; Liting Wang; Ye Peng; Xiaomin Wan

doi:10.1007/s12325-021-01785-9

Cost-Effectiveness of Atezolizumab Plus Chemotherapy as First-Line Therapy for Metastatic Urothelial Cancer

Adv Ther. 2021 Jun;38(6):3399-3408. doi: 10.1007/s12325-021-01785-9. Epub 2021 May 21.

Authors

Shuxia Qin¹, Lidan Yi¹, Sini Li², Chongqing Tan¹, Xiaohui Zeng³, Liting Wang¹, Ye Peng¹, Xiaomin Wan⁴

Affiliations

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.

PMID: 34019245
DOI: 10.1007/s12325-021-01785-9

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.

Keywords: Atezolizumab; Bladder cancer; Cost-effectiveness; Markov model; Urothelial carcinoma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antibodies, Monoclonal, Humanized
Antineoplastic Combined Chemotherapy Protocols* / therapeutic use
Cost-Benefit Analysis
Humans
Neoplasms*
Quality-Adjusted Life Years

Substances

Antibodies, Monoclonal, Humanized
atezolizumab