Virtual Library

Start Your Search

Julian Nam



Author of

  • +

    P3.04 - Immunooncology (Not CME Accredited Session) (ID 970)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
    • +

      P3.04-17 - Cost-Effectiveness of Atezolizumab for Previously Treated Advanced or Metastatic Non-Small Cell Lung Cancer (NSCLC) in Canada (ID 13497)

      12:00 - 13:30  |  Author(s): Julian Nam

      • Abstract
      • Slides

      Background

      Atezolizumab is a humanized monoclonal antibody targeting PD-L1 that enhances tumour-specific T-lymphocyte responses. The efficacy and safety of atezolizumab versus docetaxel was demonstrated in patients with advanced NSCLC previously treated with chemotherapy in the phase III OAK trial (NCT02008227). Here, we report the cost-effectiveness in Canada of atezolizumab compared with docetaxel and nivolumab in previously-treated advanced NSCLC.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A cost-utility analysis was performed to estimate the cost per quality-adjusted life-year (QALY) associated with atezolizumab treatment compared to docetaxel and nivolumab in previously-treated advanced NSCLC. A three-state partitioned-survival model was developed, and the target population reflected patients in the OAK study. The analysis was conducted using a 10-year time horizon from the perspective of the Canadian publicly-funded healthcare system. Treatment efficacy was informed by the OAK trial (data cut-off date of January 23, 2017), with crossover adjustment. Overall survival (OS), progression-free survival (PFS), and time to treatment discontinuation (TTD) for atezolizumab were estimated by parametric extrapolation of Kaplan-Meier (KM) data from OAK. For OS, a cure modelling approach was used with an assumed cure fraction of 1% for atezolizumab to represent long-term survivorship as seen with cancer immunotherapy. OS, PFS and TTD for docetaxel and nivolumab were estimated through network meta-analysis of randomized controlled trials. A discount rate of 1.5% was applied in the base case to costs and effects. Costs considered in the analysis included treatments and administration, supportive care, adverse events management, subsequent treatments, and terminal care. Most costs were obtained from publicly-available sources. Health-related quality of life was estimated using EQ-5D-3L data from OAK. All analyses were performed probabilistically, and several scenario analyses were performed to assess the robustness of results.

      4c3880bb027f159e801041b1021e88e8 Result

      The base-case incremental cost per QALY for atezolizumab versus docetaxel was $142,074 (2017 CAD). Atezolizumab resulted in more QALYs and less costs compared to nivolumab; however, differences were small. Docetaxel had the highest probability of being cost effective at a willingness-to-pay (WTP) threshold below $125,000/QALY; the probability that atezolizumab was cost effective approached 40% at WTP thresholds beyond $125,000/QALY. Results were generally consistent in scenario analyses.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The ICER of atezolizumab vs. docetaxel used as second-line treatment for advanced NSCLC was $142,074/QALY. Atezolizumab dominated nivolumab; however, differences were small. The results of our analysis, as well as the added convenience of a fixed-dose regimen administered every three weeks, support the use of atezolizumab for patients in Canada with advanced NSCLC after progression on chemotherapy.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.