OBJECTIVES: Adjuvant atezolizumab vs. best-supportive care (BSC) after complete resection and adjuvant platinum-based chemotherapy in patients with early-stage resected non-small cell lung cancer (NSCLC) was evaluated in IMpower010 trial, showing an improvement in disease-free survival (DFS) in favor of atezolizumab. We aimed to assess the cost-effectiveness of adjuvant atezolizumab in the treatment of early-stage NSCLC patients (stage II-IIIA) with expression of programmed death-ligand 1 PD-L1≥50% without mutations in EGFR or ALK rearrangements in Spain.

METHODS: A 5-states Markov model (DFS, locorregional recurrence, 1L-metastatic recurrence, 2L-metastatic recurrence, and death) was adapted to the Spanish setting. Demographic characteristics, DFS curves, and safety parameters were obtained from IMpower010. Transition probabilities from locorregional and metastatic health states were obtained from the literature. Healthcare resources were obtained from a Spanish cost analysis performed by the same panel of experts that validated all the parameters of this analysis. A societal perspective was adopted (€ 2021) so both direct and indirect costs were considered. A lifetime horizon was used so a 3% discount rate for future costs and outcomes was considered. Both deterministic and probabilistic sensitivity analyses were performed to assess uncertainty and verify the robustness of the base case results.

RESULTS: The use of adjuvant atezolizumab is associated with greater effectiveness (+2.61 life years [LY] and +1.95 quality-adjusted life years [QALY]) but a higher cost (+22,538€) compared to BSC. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) of the analysis were €8,625/LY gained and €11,583/QALY gained, respectively. The sensitivity analyses carried out showed that the uncertainties are manageable, and the results of the analysis are robust.

CONCLUSIONS: The results of the cost-effectiveness analysis show that adjuvant treatment with atezolizumab in patients with early-stage resected NSCLC is cost-effective versus BSC since the ICERs and ICURs obtained are below the cost-effectiveness thresholds commonly considered.