Cost-effectiveness Analysis Of Adjuvant Therapy With Atezolizumab In Chinese Patients With Stage ⅠB-ⅢA Resectable NSCLC After Adjuvant Chemotherapy

Objectives: From the perspective of China ’s health care system and in combination with the current economic development status in China,this study will investigate the cost-effectiveness of atezolizumab and best supportive care as adjuvant therapy for patients with stage IB-IIIA resectable NSCLC after chemotherapy,providing decisionmaking and scientific research evidence for Chinese medical workers to practice value medical care,medical insurance policy formulation and rational allocation of health resources,so as to ensure that patients and their families can achieve both economic and effective treatment options.Methods: Markov models were constructed based on follow-up data from the IMpower010 trial and assessed separately in the PD-L1 TC ≥ 1% stage II-IIIA group,all stage II-IIIA groups,and the intention-to-treat group(stage IB-IIIA).Efficacy and safety data were obtained from the IMpower010 trial,and costs and utility values were derived from the literature and local surveys to estimate their incremental costeffectiveness ratios(ICERs)compared with willingness-to-pay(WTP)thresholds in scenarios implementing patient assistance programs or drug price negotiations.According to the results of unitary sensitivity analysis and probabilistic sensitivity analysis,the stability of model results is discussed.Results: Compared with best supportive care,atezolizumab produced an additional0.45 QALYs,0.04 QALYs,and-0.0028 QALYs in the PD-L1 TC ≥ 1% stage II-IIIA group,all stage II-IIIA groups,and the intention-to-treat group,and the ICERs were108,825.37/QALY,1,028,538.22/QALY,and-14,381,171.55/QALY,respectively.The ICERs all exceeded the WTP threshold of $27,354 per QALY(three times the per capita gross domestic product of China in 2022),and univariate sensitivity analysis showed that the price of atezolizumab played a crucial role in the model results.Probabilistic sensitivity analysis showed that the probability of cost-effectiveness of atezolizumab in the PD-L1 TC ≥ 1% stage II-IIIA group,all stage II-IIIA groups,and the intention-totreat group(IB-IIIA)increased with increasing WTP threshold.Conclusions: In the context of China ’s healthcare system,in the PD-L1 TC ≥ 1%stage II-IIIA group,all stage II-IIIA groups,and the intention-to-treat group,atezolizumab is used as adjuvant therapy for early stage NSCLC after platinum-based chemotherapy is unlikely to be cost-effective.The implementation of PAP or price reduction negotiations for atezolizumab might be among the most effective measures to improve its cost-effectiveness.