Estimating recurrences prevented and costs avoided with atezolizumab in early non‐small cell lung cancer in the United States

• Published in: Cancer medicine (Malden, MA) MA), 2023-03, Vol.12 (6), p.7450-7458
• Main Authors: Sharma, Rishika, Ogale, Sarika, Smith, Nathaniel J., Lee, Janet Shin
• Format: Article
• Language: English
• Subjects: Adult; Antibodies, Monoclonal, Humanized - therapeutic use; atezolizumab; Cancer therapies; Carcinoma, Non-Small-Cell Lung - drug therapy; Chemotherapy; Clinical trials; Confidence intervals; cost simulation; Cost-Benefit Analysis; Costs; early NSCLC; Emergency medical care; Epidemiology; Humans; Immunotherapy; Lung cancer; Lung Neoplasms - drug therapy; Monte Carlo simulation; Mortality; Nervous system; Non-small cell lung carcinoma; Palliative care; PD-L1 protein; Pharmacy; Population studies; prevention; recurrence; Small cell lung carcinoma; Tumors; United States - epidemiology
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.5462

Background Recurrence of early‐stage non‐small cell lung cancer (eNSCLC) is associated with significant mortality and costs. Atezolizumab (ATZ) was recently approved as adjuvant treatment following resection and platinum‐based chemotherapy for adults with stage II‐IIIA NSCLC with PD‐L1 expression ≥1% after demonstrating significant improvement in disease‐free survival (DFS) relative to best supportive care (BSC) in the IMpower010 trial (NCT02486718). This study evaluated the population‐level impact of ATZ as adjuvant treatment for eNSCLC in the United States by estimating the number and costs of recurrences avoided. Methods A Monte Carlo simulation model estimated the cumulative number of recurrences and deaths prevented, along with direct, indirect, and terminal care costs, by treating eNSCLC patients with ATZ compared to BSC. The model included eligible patients treated in any given year and followed over a 5‐year period. Recurrence and mortality rates and costs were based on the IMpower010 data and supplemented by estimates from published literature. Results An estimated 4400 eNSCLC patients in the United States were eligible for adjuvant ATZ in any given year, of whom 2387 would experience recurrence within 5 years with BSC. Following the introduction of ATZ, 1030 (95% confidence interval [CI]: 1023, 1036) recurrences and 369 (95% CI: 362, 376) deaths would be avoided with estimated reductions in cumulative recurrence‐related direct, indirect, and terminal care costs of $785 million, $15 million, and $32 million, respectively, over a 5‐year time horizon. Conclusions Adjuvant ATZ is estimated to prevent a significant number of recurrences and reduce the economic burden of eNSCLC. Adjuvant atezolizumab is estimated to prevent a significant number of recurrences and reduce the economic burden of early non‐small cell lung cancer.