A cost–utility analysis of atezolizumab in the second-line treatment of patients with metastatic bladder cancer

Background Despite initial promising results, the IMvigor211 clinical trial failed to demonstrate an overall survival (os) benefit for atezolizumab compared with chemotherapy in the second-line treatment of metastatic bladder cancer (mbc). However, given lessened adverse events (aes) and preserved quality of life (qol) with atezolizumab, there might still be investment value. To evaluate that potential value, we conducted a cost–utility analysis (cua) of atezolizumab compared with chemotherapy from the perspective of the Canadian health care payer. Methods A partitioned survival analysis model was used to evaluate atezolizumab compared with chemotherapy over a lifetime horizon (5 years). The base-case analysis was conducted for the intention-to-treat (itt) population, with additional scenario analyses for subgroups by IMvigor-defined PD-L1 status. Effectiveness was evaluated through life–year gains and quality-adjusted life–years (qalys). Cost estimates in 2018 Canadian dollars for systemic treatment, aes, and end-of-life care were incorporated. The incremental cost-effectiveness ratio (icer) was used to compare treatment strategies. Parameter and model uncertainty were assessed through sensitivity and scenario analyses. Per Canadian guidelines, cost and effectiveness were discounted at 1.5%. Results For the itt population, the expected qalys for atezolizumab and chemotherapy were 0.75 and 0.56, with expected costs of $90,290 and $8,466 respectively. The resultant icer for atezolizumab compared with chemotherapy was $430,652 per qaly. Scenario analysis of patients with PD-L1–positive tumours led to a lower icer ($334,387 per qaly). Scenario analysis of observed compared with expected benefits demonstrated a higher icer, with a shorter time horizon ($928,950 per qaly). Conclusions Despite lessened aes and preserved qol, atezolizumab is not considered cost-effective for the second-line treatment of mbc.

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A cost-utility analysis of atezolizumab in the second-line treatment of metastatic urothelial carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.6639 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 6639-6639

Author(s):

Ambika Parmar ◽

Marina Richardson ◽

Beate Sander ◽

Susanna Y. Cheng ◽

Kelvin K. Chan

Keyword(s):

Cost Effectiveness ◽

Urothelial Carcinoma ◽

Cost Utility ◽

Cost Utility Analysis ◽

Line Treatment ◽

Second Line ◽

Utility Analysis ◽

Lifetime Horizon ◽

Metastatic Urothelial Carcinoma

6639 Background: Despite early promising results, IMvigor211 failed to demonstrate an overall survival benefit for atezolizumab, compared to chemotherapy, in the second-line treatment of metastatic urothelial carcinoma. However, given improvements in adverse events (AE) and quality of life with atezolizumab, there may still be investment value. We conducted a cost-utility analysis (CUA) of atezolizumab compared to chemotherapy from a public-payer healthcare perspective. Methods: We developed a partitioned survival model to evaluate atezolizumab versus chemotherapy (i.e. docetaxel, paclitaxel or vinflunine). IMvigor211 informed rates of treatment receipt (initial and subsequent), AE, effectiveness and utility estimates. Cost for treatment, AE and death were based on published literature (adjusted to 2018 Canadian dollars). Per health state, cost of treatment (initial and subsequent) and AE were incorporated. Outcomes included quality-adjusted life-years (QALY), cost per treatment, and incremental cost-effectiveness ratio (ICER). QALY and cost were discounted at 1.5% (Canadian guidelines). Parameter uncertainty was assessed through one-way and scenario analyses. Time horizons of 2 (within trial) and 5 years (extrapolated lifetime) were evaluated. Results: QALY of atezolizumab and chemotherapy over 2 years (lifetime) were 0.65 (0.93) and 0.58 (0.64), respectively. Cost of atezolizumab and chemotherapy over 2 years (lifetime) was $77,614.64, ($92,484.34), and $62,212.35 ($67,606.65), respectively. ICER over 2 years and lifetime was $220,032.71/QALY and $85,785.14/QALY. Scenario analysis from a North American perspective with only taxane chemotherapy with and without third line immunotherapy (IO) revealed an ICER of $80,144.90/QALY, $125,332.76/QALY over a lifetime horizon, respectively. Conclusions: The difference in ICER dependent on time horizon, driven by extrapolated survival benefits, highlights the importance of long-term follow-up to examine whether early evidence for durable response translates into long-term survival and improvements in cost-effectiveness. Thus, CUA of IO require careful interpretation and warrant dynamic assessment as new data becomes available.

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Cost-Utility Analysis of Maintenance Therapy with Either Gemcitabine or Erlotinib versus Observation with Predefined Second-Line Treatment after Cisplatin-Gemcitabine Induction Chemotherapy in Advanced Nsclc: Ifct-Gfpc 0502-ECO Phase III Study

Annals of Oncology ◽

10.1016/s0923-7534(20)33773-x ◽

2012 ◽

Vol 23 ◽

pp. ix397-ix398

Author(s):

I. Borget ◽

M. Perol ◽

D. Perol ◽

A. Lavole ◽

L. Greillier ◽

...

Keyword(s):

Maintenance Therapy ◽

Induction Chemotherapy ◽

Advanced Nsclc ◽

Cost Utility ◽

Cost Utility Analysis ◽

Phase Iii ◽

Line Treatment ◽

Second Line ◽

Utility Analysis ◽

Phase Iii Study

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A cost-utility analysis of apalutamide for the treatment of patients with metastatic castration-sensitive prostate cancer (mCSPC).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19369 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19369-e19369

Author(s):

Ambika Parmar ◽

Narhari Timilshina ◽

Urban Emmenegger ◽

Shabbir M.H. Alibhai ◽

Martin Smoragiewicz ◽

...

Keyword(s):

Cost Effectiveness ◽

Scenario Analysis ◽

Cost Utility ◽

Cost Utility Analysis ◽

Base Case ◽

Utility Analysis ◽

Lifetime Horizon ◽

Healthcare Perspective ◽

Canadian Healthcare ◽

Titan Trial

e19369 Background: The therapeutic landscape for patients with mCSPC has evolved over the last decade given the growing body of evidence demonstrating efficacy for the earlier application of oral androgen receptor signaling inhibitors, such as with abiraterone and enzalutamide. Recently the success of the TITAN trial established the superior efficacy of apalutamide combined with androgen deprivation therapy (ADT), with a 33% reduction in mortality versus ADT alone, and a tolerable toxicity profile. However, with substantially higher costs than ADT alone, the cost-effectiveness of this combination is critical to evaluate. Methods: A cost-utility analysis of apalutamide+ADT versus ADT alone was conducted from the Canadian healthcare perspective. A state-transition model with probabilistic analysis was used to compare the two strategies over a lifetime horizon. Model inputs were informed by the TITAN trial (transition probabilities, adverse events [AE], subsequent therapy), published literature (utilities) and Canadian costing resources (systemic therapy [initial and subsequent], routine care [physician visits, imaging], AE, end-of-life care costs). Primary outcomes included expected life-year gains (LYG), quality-adjusted life-years (QALY), lifetime cost (in 2018 Canadian dollars), and the incremental cost-effectiveness ratio (ICER). Multiple scenario analyses were conducted to assess parameter and model uncertainty. Cost and effectiveness were discounted at 1.5% as per Canadian guidelines. Results: From the base-case analysis expected LYG and QALY for ADT and apalutamide+ADT were 4.11, 5.57 and 3.50, 4.85, respectively. Expected cost over a lifetime horizon was $37,553 and $254,205, respectively. The ICER for apalutamide+ADT as compared to ADT alone was $160,483/QALY. Through scenario analysis, cost-effectiveness of apaluatmide+ADT was achieved with apalutamide price reductions of >50%, relative to a cost-effectiveness threshold (CET) of $100,000/QALY. Scenario analysis of alternative long-term survival expectations with apalutamide+ADT demonstrated cost-effectiveness (relative to CET $100,000/QALY) with expected improvements in the 5-year survival rate of 29% as compared to ADT (versus base-case expected improvement in 5-year survival of 15%). Conclusions: Apalutamide+ADT is unlikely to be cost-effective from the Canadian healthcare perspective at current list prices. Improvement in cost-effectiveness is most likely to be achieved through price reductions in apalutamide drug costs.

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