Cost-effectiveness of adjuvant atezolizumab versus best supportive care in the treatment of patients with resectable early-stage non-small cell lung cancer and overexpression of PD-L1

Figures & data

Figure 1. Diagram of the Markov model. DFS, disease-free survival; eNSCLC, early non-small cell lung cancer; 1L, first line; 2L, second line.

Table 1. Transition probabilities.

Transition type		Reference		Transition probability
Transition probabilities from locoregional (to 1 L-metastatic or death)
Remission to 1 L-m recurrence or Death	Having received CRT	mPFS: 19	Nakamichi et al.^16	0.036
	Having received only RT	mPFS: 10.6		0.065
Remission to Death	Having received palliatives	mOS: 5.1	Kruser et al.^14	0.136
Transition from 1 L-metastatic (to 2 L-metastatic or death)
1L-m recurrence to 2L-m recurrence or Death	After 1 L IT	mPFS: 11.07	IMpower150^18	0.063
	After 1 L CT	mPFS: 6.77		0.102
2L-m recurrence to Death	After 2 L IT	mOS: 13.75	OAK^19	0.05
	After 2 L CT	mOS: 9.62		0.072

Table 2. Treatments distribution in each health state.

Health state		Treatment
DFS		atezolizumab (1,200 mg every 3 weeks for up to 16 cycles) vs BSC
Locoregional recurrence	Curative	CT: cisplatin plus vinorelbine/RT/Surgery
	Palliative	CT: cisplatin plus vinorelbine
Progression of disease		<12 m (re-challenging disallowed)	>12 m (re-challenging allowed)
Metastatic recurrence 1 L	Active treatment	100% cisplatin + pemetrexed	91% pembrolizumab 9% carboplatin + pemetrexed + pembrolizumab
	Palliative	100.00% BSC
Metastatic recurrence 2 L	Active treatment	50% docetaxel + nintedanib 50% docetaxel	19% docetaxel + nintedanib 18% docetaxel 63% cisplatin + pemetrexed
	Palliative	100.00% BSC

Table 3. Base case results.

	ATZ	BSC	Incremental
Direct costs	€107,073	€76,998	+€30,075
Treatment-derived costs	€95,259	€60,591	+€34,667
Healthcare resource consumption costs	€6,729	€8,974	‒€2,245
Adverse events management costs	€1,028	€580	+€448
End-of-life costs	€4,057	€6,853	‒€2,796
Indirect costs	€25,404	€32,941	‒€7,537
Total Costs	€132,477	€109,939	+€22,538
LY	11.74	9.13	2.61
QALY	8.65	6.7	1.95
ICER (in € per LY gained)			€8,625 /LY
ICUR (in € per QALY gained)			€11,583 /QALY

Figure 2. Tornado diagram. DFS, disease-free survival; ICUR, incremental cost-utility ratio; Ind, indirect costs; IV, intravenous; QALY, quality-adjusted life year; 1L, first line; 2L, second line.

Figure 3. Incremental cost-effectiveness plane. ATZ, atezolizumab; BSC, best supportive care; Inc, incremental; QALYs, quality-adjusted life years

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