Aligning Cost-Effective Payer Strategies With Clinical Pathway Considerations for NSCLC Treatment

Millie Das, MD, shares key takeaways from her presentation regarding cost-effective strategies and payer considerations related to the treatment of NSCLC.

Millie Das, MD: I presented an e-poster looking at the cost-effectiveness of atezolizumab for adjuvant treatment in the FDA-labeled patient population. These are stage II and IIIA patients who are PD-L1–positive who have undergone resection. For many years in early stage non–small cell lung cancer, the standard adjuvant treatment option has been chemotherapy. Now we have our first immunotherapy indication in this adjuvant non–small cell lung cancer space. It’s important to see whether the additional cost of immunotherapy is worth it, especially with the knowledge that immunotherapy can be expensive compared with many of our chemotherapy drugs. We did this cost-effective analysis to try to answer this question.

Using a standard Markov model with obtained inputs from clinical trials and the published literature, we reported the cost for quality of life as being $61,000 and a cost per year of $46,000. Using a willingness to pay threshold of $150,000, atezolizumab was found to be cost-effective. We need to consider costs related to disease recurrence that can lead to detriment in quality of life and increased rates of hospitalization. These were the key drivers for why atezolizumab was found to be cost-effective.

In the value-based health care landscape, this study helps support pathway inclusion decisions to help guide patients with early stage non–small cell lung cancer to the most appropriate and cost-effective treatments available. These results combined should help payers as they think about the treatment we should be offering our patients with early stage non–small cell lung cancer. We’re seeing meaningful disease-free survival benefit with adjuvant atezolizumab and a trend in overall survival benefit in this patient population with stages II and IIIA disease with a PD-L1 greater than or equal to 1%. These results are clinically meaningful.

As of October 2021, when adjuvant atezolizumab was FDA approved, this was something that all of us who work in lung cancer were excited to offer to our eligible patients in the clinic. These recent data lend support to clinical adoption.

Transcript edited for clarity.

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