Cost-effectiveness Analysis Of Atezolizumab As First-line Treatment For Advanced Urinary Tumor

ObjectiveTo evaluate the economics of atezolizumab for the first-line treatment of metastatic renal cell carcinoma(m RCC)and advanced urothelial carcinoma(UC),respectively,with the aim of promoting clinical rational drug use and providing a reference for rational allocation of pharmaceutical resources by health care and health policymakers.MethodsThe Markov models of three health states applicable to m RCC and advanced UC were constructed by combining the clinical trial data and associated drugs and treatment costs through the Tree Age Pro 2019 software.Cost-effectiveness analyses were conducted to evaluate the economics of the atezolizumab treatment regimen using life-year(LY),quality-adjusted life-year(QALY)and incremental cost-utility ratio(ICUR)as the primary outcome indicators,and one-way sensitivity analyses and probabilistic sensitivity analyses were performed on the relevant parameters affecting the outcome.1 The cost-effectiveness of atezolizumab combined with bevacizumab(Ate & Bev)for patients with untreated m RCC was evaluated by extracting the data from Kaplan-Meier survival curves reported in the IMmotion-151 trial and constructing a6-week-cycle Markov model,from the perspective of the US payer.2 Treatment-related costs in the United States(US)and China were acquired separately to evaluate the economics of atezolizumab combined with chemotherapy(Ate & Chemo)as the first-line treatment for advanced UC in both countries.Treatment drug prices were obtained from the Red Book website and evaluated from the US payer perspective;winning drug prices were obtained from the Yaozhi.com and analyzed from the Chinese health care system perspective.Results1 Compared to sunitinib monotherapy,Ate & Bev treatment yielded additional0.43 QALY and a concomitant increment in cost of $108,842,with the corresponding ICUR of $253,831/QALY,which is higher than the given willingness-to-pay(WTP)threshold of $150,000/QALY in the US.The one-way sensitivity analysis predicted that the price of the Ate & Bev treatment had the most significant effect on the ICUR.The results of the probabilistic sensitivity analysis showed that the Ate & Bev regimen had a 50.7% probability of being cost-effective as the first-line treatment for m RCC compared to sunitinib monotherapy.2 For patients with advanced UC,the survival benefit of first-line treatment with Ate & Chemo regimen and chemotherapy regimen was 0.94 and 0.79 QALY,respectively.From the US payer perspective,the incremental cost was $56,184,and the ICUR was $373,707/QALY,which was above the WTP threshold of $150,000/QALY.From the Chinese health care system perspective,the incremental cost was $31,343 and the corresponding ICUR was $218,832/QALY,which also exceeded the WTP threshold of 3 times China’s GDP per capita($30,829/QALY).The probability of Ate & Chemo treatment being cost-effective compared to chemotherapy regimen was 5.5% and 4.6%in the US and China,respectively.In the US,reducing the price of atezolizumab to40% of the original price would make the Ate & Chemo a cost-effective regimen.In China,the Ate & Chemo treatment could be cost-effective when the price of atezolizumab was lower than $950.93/1200 mg.Conclusion1 Atezolizumab plus Bevacizumab was determined to be not cost-effective compared to sunitinib as the first-line treatment of metastatic renal cell carcinoma in the context of the US payer.The results of the probabilistic sensitivity analysis showed that the probability of Atezolizumab plus Bevacizumab being economical was 50.7%.2 For patients with advanced urothelial carcinoma,the survival benefit of first-line treatment with the Atezolizumab plus Chemotherapy regimen and chemotherapy was0.94 and 0.79 QALY,respectively.From the US payer perspective,the incremental cost was $56,184,and the ICUR was $373,707/QALY,which was above the WTP threshold of $150,000/QALY.From the Chinese health care system perspective,the incremental cost was $31,343 and the ICUR of $21,832 also exceeded the WTP threshold of 3 times China’s GDP per capita($30,829/QALY).The probability of Atezolizumab plus Chemotherapy being cost-effective compared to chemotherapy regimen was 5.5% and4.6% in the US and China,respectively.In the US,reducing the price of atezolizumab to 40% of the original price would make Atezolizumab plus Chemotherapy cost-effective.In China,the Atezolizumab plus Chemotherapy treatment could be cost-effective when the price of Atezolizumab was lower than $950.93/1200 mg.