Perioperative Immunotherapy, Cost-Effectiveness in Patients With NSCLC

Both adjuvant atezolizumab and neoadjuvant nivolumab plus chemotherapy for resectable NSCLC were approved by the US Food and Drug Administration recently based on positive results from the IMPOWER010 and CheckMate 816 studies, respectively. Results of a study that analyzed the cost-effectiveness (CE) of these two different treatment methods in various clinical scenarios and then indirectly compared them were presented at the ESMO Congress 2023.

The researchers defined CE as the incremental cost-effectiveness ratio (ICER), a measure of the cost difference per quality-adjusted life-years gained (QALY). Markov models were constructed to calculate the ICER of both neoadjuvant nivolumab plus chemotherapy versus neoadjuvant chemotherapy and adjuvant atezolizumab versus standard of care (SOC; surveillance ± chemotherapy). CE was assessed in the intention-to-treat population (all stage IB-IIIA) and the PD-L1 ≥1% group for the neoadjuvant nivolumab method. The CE of adjuvant atezolizumab was evaluated for the stage II-IIIA PD-L1 ≥1% and PD-L1 ≥50% groups. Each of these four clinical scenarios were divided into three sub-scenarios based on the use and assumed effectiveness of IO at recurrence in the experimental arms: 1, no IO at recurrence; 2, IO at recurrence but ineffective; and 3, IO at recurrence and effective.

Results showed that in 11 of 12 scenarios, the experimental arms were less costly and more effective than SOC. Only adjuvant atezolizumab used in PD-L1 ≥1% patients with ineffective IO at recurrence resulted in a cost increase per QALY gained as compared with SOC. The researchers concluded that “further analyses can be done to confirm CE with publication of final overall survival results.”

Source: Muthusamy B. Comparing the cost-effectiveness of perioperative immunotherapy strategies in non-small cell lung cancer. Abstract of a poster presented at the ESMO Congress 2023; October 20-24, 2023; Madrid, Spain.

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