First-line Treatment With Atezolizumab Plus Nab-paclitaxel For Advanced Triple-negative Breast Cancer: A Cost-utility Analysis

ObjectiveA Markov model was constructed incorporating recent phase III clinical trial(IMpassion130)data to evaluate the cost-utility of atezolizumab in combination with nab-paclitaxel(An P)against nab-paclitaxel(n P)monotherapy as the first-line treatment for advanced triple-negative breast cancer(TNBC)in the US and China.Methods1.A Markov model was established to simulate the dynamic changes of progression-free survival,disease progression and death in advanced TNBC intention to treat(ITT)and programmed death ligand 1(PD-L1)positive patients who received An P and nP regimens,respectively.2.The Markov model was used for Roll back and Cohort analysis to calculate the cost and utility values of the An P and n P regimens.3.Uncertainty was addressed using one-way and probabilistic sensitivity analyses.4.Markov model was verified to investigate the rationality.5.A Markov model was developed to evaluate the cost-utility of An P over a lifetime from the US health care payer and Chinese health care system perspective.6.Model inputs were derived from IMpassion130 and published literature.The primary outcomes of the model were life years(LYs),quality-adjusted life years(QALYs)and incremental cost-utility ratios(ICURs).Results1.For the ITT population,the projected mean outcome was better with An P(1.87 LYs and 1.41 QALYs)than with nab-paclitaxel alone(1.29 LYs and 0.99 QALYs).Similar results were obtained for the programmed death ligand 1(PD-L1)-positive population,with the obtained mean outcomes of 1.66 and 0.88 QALYs,respectively.2.For the US,the ICUR values comparing AnP with nab-paclitaxel were $331,996.89 per QALY and $229,359.88 per QALY gained for the ITT and PD-L1-positive populations,respectively.For China,the ICUR values were $106,339.26 per QALY and$72,971.88 per QALY gained for the ITT and PD-L1-positive populations,respectively.The one-way sensitivity analysis indicated that the price of atezolizumab was the most influential factor in our study.3.An P had 0% cost-utility at the willingness to pay thresholds of $150,000/QALY in the US and $29,383/QALY in China.Conclusions1.In conclusion,although AnP had more superior clinical outcome than nab-paclitaxel as the first-line treatment for advanced TNBC,the results of our study suggested that the addition of atezolizumab to nab-paclitaxel would not be a cost-utility strategy.Lowering the price of atezolizumab may be a major measure to improve its cost-utility.2.Our analysis can not only provide critical information to health care decision makers,but also provide a reference for the listing of atezolizumab in China.