scholarly journals Cost-effectiveness of strategies to increase cervical screening uptake at first invitation (STRATEGIC)

2017 ◽  
Vol 25 (2) ◽  
pp. 99-109 ◽  
Author(s):  
Apostolos Tsiachristas ◽  
Matthew Gittins ◽  
Henry Kitchener ◽  
Alastair Gray
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cervical Screening ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Screening Uptake ◽  
Life Years ◽  
Nurse Navigator ◽  
Lifetime Costs ◽  
Intervention Costs

Objective To assess the cost-effectiveness of strategies to increase cervical cancer screening uptake at first invitation (STRATEGIC trial). Methods We performed an economic analysis alongside the STRATEGIC trial, comparing each of seven novel interventions for improving cervical screening uptake with control general practices in Greater Manchester and Grampian (United Kingdom). A template was developed to measure the intervention costs. Trial estimates of screening uptake were combined with data from the literature to estimate healthcare costs of each intervention. The added lifetime costs and quality adjusted life years (QALYs) of attending cervical screening were estimated by a systematic literature review, with relevant results pooled and weighted by study quality. Trial results and estimated lifetime costs and benefits of screening were then combined in a decision analytic model, giving an incremental cost per QALY gained for each intervention. Uncertainty was addressed in probabilistic and univariate sensitivity analyses. Results Intervention costs per screening round per woman attending varied from about £1.20 (2014 UK) for the nurse navigator intervention to £62 for the unrequested HPV self-sampler kit. The meta-analysis revealed a lifetime discounted benefit from screening of 0.043 QALYs per woman attending, at an additional lifetime discounted cost of £234. The incremental cost per QALY gained in all interventions was below £13,000. Probabilistic sensitivity analyses suggested that only unrequested self-sampling and timed appointments have a high probability of being cost-effective. Conclusions Unrequested self-sampling and timed appointments are likely to be cost-effective interventions. Further research is required on the duration of effects and on implementing combinations of interventions.

CyberKnife for prostate cancer: Is it cost-effective?

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 87-87 ◽  
Author(s):  
A. Parthan ◽  
N. Pruttivarasin ◽  
D. Taylor ◽  
D. Davies ◽  
G. Yang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Societal Perspective ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Life Years ◽  
Lifetime Costs

87 Background: The study assessed the cost-effectiveness of CyberKnife (CK) compared to surgery and radiation therapy for the treatment of prostate cancer (PC) from a third-party and societal perspective. Methods: For patients > 65 yrs with localized PC, a Markov model compared treatment with CK, intensity modulated radiation therapy (IMRT), surgery or proton therapy (PT). Following treatment, patients were at risk of long-term toxicity: genitourinary (GU); gastrointestinal (GI); and sexual dysfunction (SD). Long-term toxicity was defined as adverse events >grade 2 on Radiation Therapy Oncology Group scale occurring at least 12 months following treatment. Markov states included all possible combinations of GI, GU, and SD long-term toxicities, no toxicity, and death. During each year patients remained in the same Markov state or died. Costs and utilities were assigned using published sources. Toxicity probabilities were derived using meta-analytical techniques to pool results from multiple studies. It was assumed that long-term disease control would not differ across treatments. The model projected expected lifetime costs and quality adjusted life years (QALYs) for each treatment and incremental cost-effectiveness of CK vs comparators as cost per QALY gained. Costs from societal perspective included lost productivity. Extensive sensitivity analyses were conducted. Results: Surgery was the least expensive treatment option followed by CK. CK patients had higher expected QALYs (8.11) than other treatment options (7.72- 8.06). From a payer perspective, total lifetime costs were $25,904, $22,295, $38,915, and $58,100 for CK, surgery, IMRT and PT, respectively. Incremental cost per QALY gained for CK versus Surgery was $9,200/QALY. Compared to IMRT and PT, CK was less costly and resulted in higher QALYs (dominance). At a threshold of $50,000/QALY, CK was cost effective in 86%, 79%, and 91% of simulations compared to surgery, IMRT, and PT, respectively. From a societal perspective, CK costs $4,200/QALY compared to surgery and remained dominant vs IMRT and PT. Results were most sensitive to costs of surgery and CK. Conclusions: Initial CK costs are higher than surgery, but CK patients have better quality of life. CK patients have lower lifetime costs and higher QALYs than IMRT and PT patients. [Table: see text]

Cost-effectiveness of once weekly carfilzomib 70 mg/m2 plus dexamethasone in patients with relapsed and refractory multiple myeloma in the United States.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18356-e18356
Author(s):  
Shaji Kumar ◽  
Istvan Majer ◽  
Sumeet Panjabi ◽  
Jean Malacan ◽  
Rohan Medhekar ◽  
...  
Keyword(s):  
Health Care ◽  
Multiple Myeloma ◽  
Cost Effectiveness ◽  
Progression Free Survival ◽  
Cost Effective ◽  
The United States ◽  
Sensitivity Analyses ◽  
Refractory Multiple Myeloma ◽  
Life Years ◽  
Lifetime Costs

e18356 Background: Carfilzomib plus dexamethasone (Kd) dosed once weekly at 70 mg/m2 (QW Kd70) was recently approved in the US for treating patients with relapsed and refractory multiple myeloma (RRMM). To assess the cost-effectiveness (CE) of QW Kd70 vs twice weekly Kd dosed at 27 mg/m2 (BIW Kd27), data from the phase 3 ARROW trial, which directly compared these regimens in patients with 2-3 prior lines of therapy were used. Methods: A partitioned survival model was developed for the CE analysis. Time to treatment discontinuation, progression-free survival, and overall survival (OS) were estimated from the ARROW trial. Long-term OS was extrapolated using Surveillance Epidemiology and End Results registry data after matching characteristics of patients in the registry and ARROW trial. Direct costs were estimated from a US health care payer perspective. Utilities collected in the ARROW trial using the five-level version of the EuroQol questionnaire (EQ-5D-5L) were applied to estimate the quality-adjusted life years (QALYs). Uncertainty was explored using sensitivity analyses. Two subgroups of patients refractory to lenalidomide or bortezomib were assessed. Main outcomes were mean life-years (LYs), QALYs, lifetime costs, and incremental cost-effectiveness ratios (ICERs). Results: For QW Kd70 and BIW Kd27, the model predicted mean LYs of 4.17 and 3.07 years, QALYs of 2.98 and 2.03 years, and mean total lifetime costs of $444,563 and $373,364, respectively. The incremental LYs gain, QALY gain, and incremental costs of QW Kd70 vs BIW Kd27 were estimated to be 1.10 years, 0.95 year, and $71,199, respectively, resulting in an ICER of $64,595 per LY gained and $75,204 per QALY gained. For patients refractory to lenalidomide and bortezomib, similar results were found with ICERs of $79,988 and $76,793, respectively. Conclusions: In line with ARROW trial results, this CE analysis showed that QW Kd70 is expected to provide considerable additional benefit in terms of LYs and QALYs gained compared with BIW Kd27. In the RRMM setting, QW Kd70 is cost-effective with ICERs below accepted willingness to pay thresholds in US and represents an efficient utilization of the health care budget.

scholarly journals Cost-effectiveness of prevention strategies for American tegumentary leishmaniasis in Argentina

2013 ◽  
Vol 29 (12) ◽  
pp. 2459-2472 ◽  
Author(s):  
Pablo Wenceslao Orellano ◽  
Nestor Vazquez ◽  
Oscar Daniel Salomon
Keyword(s):  
Cost Effectiveness ◽  
Early Diagnosis ◽  
Incremental Cost ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Sensitivity Analyses ◽  
Cost Effectiveness Ratio ◽  
Tegumentary Leishmaniasis ◽  
Life Years ◽  
The Cost

The aim of this study was to estimate the cost-effectiveness of reducing tegumentary leishmaniasis transmission using insecticide-impregnated clothing and curtains, and implementing training programs for early diagnosis. A societal perspective was adopted, with outcomes assessed in terms of costs per disability adjusted life years (DALY). Simulation was structured as a Markov model and costs were expressed in American dollars (US$). The incremental cost-effectiveness ratio of each strategy was calculated. One-way and multivariate sensitivity analyses were performed. The incremental cost-effectiveness ratio for early diagnosis strategy was estimated at US$ 156.46 per DALY averted, while that of prevention of transmission with insecticide-impregnated curtains and clothing was US$ 13,155.52 per DALY averted. Both strategies were more sensitive to the natural incidence of leishmaniasis, to the effectiveness of mucocutaneous leishmaniasis treatment and to the cost of each strategy. Prevention of vectorial transmission and early diagnosis have proved to be cost-effective measures.

scholarly journals Cost-Effectiveness Analysis from a Randomized Controlled Trial of Tailored Exercise Prescription for Women with Breast Cancer with 8-Year Follow-Up

2020 ◽  
Vol 17 (22) ◽  
pp. 8608
Author(s):  
Louisa G. Gordon ◽  
Elizabeth G. Eakin ◽  
Rosalind R. Spence ◽  
Christopher Pyke ◽  
John Bashford ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Usual Care ◽  
Exercise Intervention ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Exercise Interventions ◽  
Care Groups ◽  
Life Years

Studies show conflicting results on whether exercise interventions to improve outcomes for women with breast cancer are cost-effective. We modelled the long-term cost-effectiveness of the Exercise for Health intervention compared with usual care. A lifetime Markov cohort model for women with early breast cancer was constructed taking a societal perspective. Data were obtained from trial, epidemiological, quality of life, and healthcare cost reports. Outcomes were calculated from 5000 Monte Carlo simulations, and one-way and probabilistic sensitivity analyses. Over the cohort’s remaining life, the incremental cost for the exercise versus usual care groups were $7409 and quality-adjusted life years (QALYs) gained were 0.35 resulting in an incremental cost per QALY ratio of AU$21,247 (95% Uncertainty Interval (UI): Dominant, AU$31,398). The likelihood that the exercise intervention was cost-effective at acceptable levels was 93.0%. The incremental cost per life year gained was AU$8894 (95% UI Dominant, AU$11,769) with a 99.4% probability of being cost effective. Findings were most sensitive to the probability of recurrence in the exercise and usual care groups, followed by the costs of out-of-pocket expenses and the model starting age. This exercise intervention for women after early-stage breast cancer is cost-effective and would be a sound investment of healthcare resources.

Economic evaluation of Avonex® (interferon beta-1a) in patients following a single demyelinating event

2005 ◽  
Vol 11 (5) ◽  
pp. 542-551 ◽  
Author(s):  
Michael Iskedjian ◽  
John H Walker ◽  
Trevor Gray ◽  
Colin Vicente ◽  
Thomas R Einarson ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Time Horizon ◽  
Interferon Beta ◽  
Cost Effective ◽  
Current Treatment ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Life Years ◽  
Analytical Time

Background: Interferon beta-1a (Avonex®)30 mg, intramuscular (i.m.), once weekly is efficacious in delaying clinically definite multiple sclerosis (CDMS) following a single demyelinating event (SDE). This study determined the cost effectiveness of Avonex® compared to current treatment in delaying the onset of CDMS. Methods: A cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) were performed from Ministry of Health (MoH) and societal perspectives. For CEA, the outcome of interest was time spent in the pre-CDMS state, termed monosymptomatic life years (MLY) gained. For CUA, the outcome was quality-adjusted monosymptomatic life years (QAMLY) gained. A Markov model was developed with transitional probabilities and utilities derived from the literature. Costs were reported in 2002 Canadian dollars. Costs and outcomes were discounted at 5%. The time horizon was 12 years for the CEA, and 15 years for the CUA. All uncertainties were tested via univariate and multivariate sensitivity analyses. Results: In the CEA, the incremental cost of Avonex® per MLY gained was $53 110 and $44 789 from MoH and societal perspectives, respectively. In the CUA, the incremental cost of Avonex® per QAMLY gained was $227 586 and $189 286 from MoH and societal perspectives, respectively. Both models were sensitive to the probability of progressing to CDMS and the analytical time horizon. The CUA was sensitive to the utilities value. Conclusion: Avonex® may be considered as a reasonably cost-effective approach to treatment of patients experiencing an SDE. In addition, the overall incremental cost-effectiveness profile of Avonex® improves if treatment is initiated in pre-CDMS rather than waiting until CDMS.

Abstract 6234: Cost-Effectiveness Analysis Demonstrates Superiority of Screening Young Athletes with 12-Lead Electrocardiogram versus History and Physical in Preventing Sudden Cardiac Death

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Matthew T Wheeler ◽  
Paul A Heidenreich ◽  
Victor F Froelicher ◽  
Mark A Hlatky ◽  
Euan A Ashley
Keyword(s):  
Cost Effectiveness ◽  
Sudden Cardiac Death ◽  
Incremental Cost ◽  
Cardiac Death ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Decision Analysis Model ◽  
Analysis Model ◽  
Young Athletes ◽  
Life Years

Sudden cardiac death (SCD) is a rare but frightening event among young athletes. The Italian experience demonstrates a reduction in athlete SCD by screening with history, physical, and 12-lead electrocardiogram (ECG). American guideline statements have not recommended ECG for screening athletes due to perceptions of high cost and unclear effectiveness. We sought to model the cost-effectiveness (CE) of history and physical (H&P), ECG plus H&P, and no screening in US high school and college competitive athletes. A decision analysis model was used. Risks, prevalence, and test characteristics were derived from the medical literature. Costs were derived from publicly available datasets. Markov processes were used to simulate the natural histories of screened athletes. One-way sensitivity analyses and Monte Carlo simulation of all variables in the estimated ranges were performed. A societal perspective was used. Screening with an ECG plus H&P has lower overall costs and better outcomes than use of H&P alone. Compared with no screening, H&P saves 0.57 life years (LY) per 1000 athletes screened at an incremental cost of $111 per athlete, yielding a CE ratio of $195,600 per LY saved (simulation based 95% CI $116,000–514,000). ECG plus H&P when compared to no screening saves 2.7 LY per 1000 athletes at an incremental cost of $199 per athlete, for a CE ratio of $74,100 per LY saved (95% CI $46,000–158,000). Probabilistic sensitivity analysis shows that ECG plus H&P is the preferred strategy over H&P in terms of cost-effectiveness in 99.5% of simulations. ECG plus H&P is cost-effective below a threshold value of $100,000 per LY saved in 89% of simulations, while H&P is cost-effective in 1% of simulations. If the reduction in SCD risk per screening-identified, at-risk athlete is below 33%, or if more than 12% of screens are false positive, screening with ECG plus H&P is no longer cost effective. ECG plus H&P is superior to H&P for screening young athletes in our cost-effectiveness model. The incremental cost of adding an ECG, including screening, secondary testing, and subsequent treatment is under $100 per athlete screened. These data should inform the ongoing debate concerning pre-participation screening of US student-athletes.

Cost-effectiveness of three different strategies for the treatment of first recurrent Clostridium difficile infection diagnosed in a community setting

2018 ◽  
Vol 39 (8) ◽  
pp. 924-930 ◽  
Author(s):  
Simon W. Lam ◽  
Elizabeth A. Neuner ◽  
Thomas G. Fraser ◽  
David Delgado ◽  
Donald B. Chalfin
Keyword(s):  
Cost Effectiveness ◽  
Clostridium Difficile ◽  
Incremental Cost ◽  
Community Setting ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Effective Regimen ◽  
Use Of Resources ◽  
Life Years ◽  
First Recurrence

AbstractObjectiveA significant portion of patients with Clostridium difficile infections (CDI) experience recurrence, and there is little consensus on its treatment. With the availability of newer agents for CDI and the added burdens of recurrent disease, a cost-effectiveness analysis may provide insight on the most efficient use of resources.DesignA decision-tree analysis was created to compare the cost-effectiveness of 3 possible treatments for patients with first CDI recurrence: oral vancomycin, fidaxomicin, or bezlotoxumab plus vancomycin. The model was performed from a payer’s perspective with direct cost inputs and a timeline of 1 year. A systematic review of literature was performed to identify clinical, utility, and cost data. Quality-adjusted life years (QALY) and incremental cost-effectiveness ratios were calculated. The willingness-to-pay (WTP) threshold was set at $100,000 per QALY gained. The robustness of the model was tested using one-way sensitivity analyses and probabilistic sensitivity analysis.ResultsVancomycin had the lowest cost ($15,692) and was associated with a QALY gain of 0.8019 years. Bezlotoxumab plus vancomycin was a dominated strategy. Fidaxomicin led to a higher QALY compared to vancomycin, at an incremental cost of $500,975 per QALY gained. Based on our WTP threshold, vancomycin alone was the most cost-effective regimen for treating the first recurrence of CDI. Sensitivity analyses demonstrated the model’s robustness.ConclusionsVancomycin alone appears to be the most cost-effective regimen for the treatment of first recurrence of CDI. Fidaxomicin alone led to the highest QALY gained, but at a cost beyond what is considered cost-effective.

scholarly journals Cost-effectiveness analysis of Vaborem in Carbapenem-resistant Enterobacterales (CRE) -Klebsiella pneumoniae infections in Italy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Francesco Saverio Mennini ◽  
Mario Gori ◽  
Ioanna Vlachaki ◽  
Francesca Fiorentino ◽  
Paola La Malfa ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Klebsiella Pneumoniae ◽  
Incremental Cost ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Sensitivity Analyses ◽  
Fixed Dose ◽  
Carbapenem Resistant ◽  
Effectiveness Analysis ◽  
Life Years

Abstract Background Vaborem is a fixed dose combination of vaborbactam and meropenem with potent activity against target Carbapenem-resistant Enterobacterales (CRE) pathogens, optimally developed for Klebsiella pneumoniae carbapenemase (KPC). The study aims to evaluate the cost-effectiveness of Vaborem versus best available therapy (BAT) for the treatment of patients with CRE-KPC associated infections in the Italian setting. Methods A cost-effectiveness analysis was conducted based on a decision tree model that simulates the clinical pathway followed by physicians treating patients with a confirmed CRE-KPC infection in a 5-year time horizon. The Italian National Health System perspective was adopted with a 3% discount rate. The clinical inputs were mostly sourced from the phase 3, randomised, clinical trial (TANGO II). Unit costs were retrieved from the Italian official drug pricing list and legislation, while patient resource use was validated by a national expert. Model outcomes included life years (LYs) and quality adjusted life years (QALYs) gained, incremental costs, incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR). Deterministic and probabilistic sensitivity analyses were also performed. Results Vaborem is expected to decrease the burden associated with treatment failure and reduce the need for chronic renal replacement therapy while costs related to drug acquisition and long-term care (due to higher survival) may increase. Treatment with Vaborem versus BAT leads to a gain of 0.475 LYs, 0.384 QALYs, and incremental costs of €3549, resulting in an ICER and ICUR of €7473/LY and €9246/QALY, respectively. Sensitivity analyses proved the robustness of the model and also revealed that the probability of Vaborem being cost-effective reaches 90% when willingness to pay is €15,850/QALY. Conclusions In the Italian setting, the introduction of Vaborem will lead to a substantial increase in the quality of life together with a minimal cost impact, therefore Vaborem is expected to be a cost-effective strategy compared to BAT.

scholarly journals Cost-Effectiveness of Interventions to Improve HIV Pre-Exposure Prophylaxis Initiation, Adherence, and Persistence among Men Who Have Sex with Men

2021 ◽  
Author(s):  
Margo M Wheatley ◽  
Gregory Knowlton ◽  
Szu-Yu Kao ◽  
Samuel M Jenness ◽  
Eva Enns
Keyword(s):  
Cost Effectiveness ◽  
Scale Up ◽  
Cost Effective ◽  
Status Quo ◽  
Sensitivity Analyses ◽  
Transmission Model ◽  
Life Years ◽  
Sex With Men ◽  
Intervention Costs ◽  
Exposure Prophylaxis

Background: To help achieve Ending the HIV Epidemic (EHE) goals of reducing new HIV incidence, pre-exposure prophylaxis (PrEP) use and engagement must increase despite multidimensional barriers to scale-up and limitations in funding. We investigated the cost-effectiveness of interventions spanning the PrEP continuum of care for men who have sex with men (MSM) in Atlanta, Georgia, a focal jurisdiction for the EHE plan. Methods: Using a network-based HIV transmission model, we simulated lifetime costs, quality-adjusted life years (QALYs), and infections averted for eight intervention strategies using a health sector perspective. Strategies included a status quo (no interventions), three distinct interventions (targeting PrEP initiation, adherence, or persistence), and all possible intervention combinations. Cost-effectiveness was evaluated incrementally using a $100,000/QALY gained threshold. We performed sensitivity analyses on PrEP costs, intervention costs, and intervention coverage. Findings: Strategies averted 0.2-4.2% new infections and gained 0.0045%-0.24% QALYs compared to the status quo. Initiation strategies achieved 20%-23% PrEP coverage (up from 15% with no interventions) and moderate clinical benefits at a high cost, while adherence strategies were relatively low cost and low benefit. Under our assumptions, the adherence and initiation combination strategy was cost-effective with an incremental cost-effectiveness ratio of $86,927/QALY gained. Sensitivity analyses showed no strategies were cost-effective when intervention costs increased by 60% and the strategy combining all three interventions was cost-effective when PrEP costs decreased to $1,000/month. Interpretation: Under reasonable assumptions of intervention uptake and cost, PrEP initiation interventions achieved moderate public health gains and could be cost-effective. However, these analyses demonstrate that substantial financial resources will be needed to improve the PrEP care continuum towards meeting EHE goals.

Cost-effectiveness of atezolizumab monotherapy versus pembrolizumab monotherapy for first-line (1L) treatment of metastatic non-small cell lung cancer (mNSCLC).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18847-e18847
Author(s):  
Chia-Wei Lin ◽  
Katherine Rosettie ◽  
Pinar Bilir ◽  
Hazal Celik ◽  
Seye Abogunrin ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Base Case ◽  
First Line ◽  
Deterministic Sensitivity Analysis ◽  
Anaplastic Lymphoma ◽  
Life Years

e18847 Background: Atezolizumab monotherapy is indicated as 1L treatment for mNSCLC patients with high programmed death ligand-1 (PD-L1) expression (≥ 50%) and without epidermal growth factor receptor or anaplastic lymphoma kinase mutations. This analysis assessed the cost-effectiveness of 1L atezolizumab monotherapy vs. pembrolizumab monotherapy for mNSCLC patients with high PD-L1 expression from a US third-party payer perspective. Methods: A Markov model with progression-free, progressive disease (PD), and death states was developed in Microsoft Excel to compare clinical and cost outcomes of atezolizumab monotherapy vs. pembrolizumab monotherapy. Efficacy, safety, and utility data were derived from systematic reviews and indirect comparisons of the IMpower110, Keynote-024, and Keynote-042 trials. Product prescribing information and clinical trials informed dosing and administration. Wholesale acquisition cost (WAC, accessed in January 2021) for drugs were used while other cost inputs were derived from publicly available fee schedules and peer-reviewed literature. The key outcome of interest was the incremental cost-effectiveness ratio (ICER) expressed as cost per quality-adjusted life-year (QALY) gained. Deterministic sensitivity analysis with 20% variation and probabilistic sensitivity analyses (PSA) were performed to address uncertainties around input parameters. Results: In the base case, 1L atezolizumab monotherapy was projected to increase life expectancy for patients by 0.60 life-years (4.35 vs. 3.75) and 0.47 QALYs (3.46 vs. 2.98) over pembrolizumab monotherapy at an incremental cost of $27,947 (mean total cost: $396,811 vs. $368,864), resulting in an ICER of $58,841/QALY gained. Results of the deterministic sensitivity analysis were most sensitive to changes in discount rates for costs and care costs in the PD state. The PSA showed that the probability of atezolizumab being cost-effective at willingness-to-pay thresholds of $100,000 and $150,000 was 41% and 49%, respectively. Conclusions: First-line atezolizumab monotherapy had 0.6 life-years and 0.47 QALYs gained compared with pembrolizumab monotherapy and was estimated to be cost-effective (ICER $58,841/QALY). As the ICER falls below the US cost-effectiveness thresholds ( < $100,000-$150,000/QALY), clinicians and payers should consider atezolizumab monotherapy as a cost-effective 1L option for mNSCLC patients with high PD-L1 expression.

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