OBJECTIVES: To assess the cost-effectiveness of atezolizumab (ATZ) as adjuvant treatment in adult patients following complete resection and platinum-based chemotherapy with non-small cell lung cancer (NSCLC) with a high risk of recurrence whose tumours have PD-L1 expression on ≥ 50% of tumour cells and who do not have EGFR mutant or ALK-positive NSCLC from the Finnish health care payer perspective.

METHODS: A 5-state Markov Model was developed to estimate the costs and benefits of adjuvant ATZ versus best supportive care (BSC) using a 30-year time horizon. The model used data from IMpower010 (clinical cut-off date January, 2021) to model disease-free survival (DFS), adjuvant ATZ treatment duration, disease recurrence and adverse events (AE). The information on utilities and clinical parameters related to advanced disease stages were from IMpower150 and IMpower110 trials and from the literature. Assumptions on treatment practice, monitoring, health care resource use and AE management were validated with the assistance of Finnish therapeutic area experts. The included costs were direct health care costs covering administration, AEs, monitoring and therapies. Cost data was sourced from public Finnish hospital pricelists and publications (indexed to year 2021) and the therapy costs were in wholesale price (May, 2022). Costs and outcomes were discounted at 3%.

RESULTS: The estimated incremental cost-effectiveness ratio of adjuvant ATZ vs. BSC is €29,911 per quality-adjusted life year (QALY), driven by therapy costs and choice of DFS parametric distribution.

CONCLUSIONS: This health economic analysis found that adjuvant atezolizumab can be considered a cost-effective treatment in Finland for NSCLC patients with a high risk of recurrence whose tumours have PD-L1 expression on ≥50% of tumour cells and who do not have EGFR mutant or ALK-positive NSCLC.