Cost-effectiveness analysis of atezolizumab plus chemotherapy as first-line treatment for patients with advanced nonsquamous non-small-cell lung cancer in China

The aim of the study was to evaluate the cost-effectiveness of adding atezolizumab to first-line chemotherapy for advanced nonsquamous non-small-cell lung cancer (NSCLC) from Chinese healthcare system. A partitioned survival model (PSM) was established to simulate 3-week patients transition in a 20-year time horizon to estimate the health and economic outcomes of adding atezolizumab to first-line chemotherapy for advanced nonsquamous NSCLC. Costs and utility values were obtained from the local charges and published studies. Sensitivity analyses were conducted to confirm the robustness of the model results. Atezolizumab plus chemotherapy yielded additional 0.36 life years (LYs) and 0.23 quality-adjusted life-years (QALYs), and the marginal cost was $60,154.48, resulting in an ICER of atezolizumab plus chemotherapy versus chemotherapy was$267,264.85/QALY. One-way sensitivity analyses revealed that the cost of atezolizumab was the main driver of the model outcomes, and the probabilistic sensitivity analyses suggested that atezolizumab plus chemotherapy had 0% probability of being cost-effective first-line option at the willingness-to-pay (WTP) threshold of $37,652/QALY in China. Atezolizumab plus chemotherapy could not be considered cost-effective compared with chemotherapy alone as the first-line strategy for patients with advanced nonsquamous NSCLC in China. And appropriately reduce the price of atezolizumab is necessary.</p

Additional file 8 of Integrated pancancer analysis reveals the oncogene characteristics and prognostic value of DIP2B in breast cancer

Additional file 8: sFigure 8. Original Western blots pictures. A: DIP2B; B: GAPDH

Additional file 1 of Integrated pancancer analysis reveals the oncogene characteristics and prognostic value of DIP2B in breast cancer

Additional file 1: sFigure 1. The flow chart of the present study

Additional file 7 of Integrated pancancer analysis reveals the oncogene characteristics and prognostic value of DIP2B in breast cancer

Additional file 7: sFigure 7. The correlation among DIP2B expression with immunostimulator related genes and immunoinhibitor related genes and chemokine receptor related genes in subtypes of BRCA. *P ≤ 0.05; **P ≤ 0.01; ***P ≤ 0.001

Additional file 2 of Integrated pancancer analysis reveals the oncogene characteristics and prognostic value of DIP2B in breast cancer

Additional file 2: sFigure 2. The expression of DIP2B in CCLE tumor cell line

Additional file 6 of Integrated pancancer analysis reveals the oncogene characteristics and prognostic value of DIP2B in breast cancer

Additional file 6: sFigure 6. The correlation among DIP2B expression with immunostimulator related genes and immunoinhibitor related genes and chemokine receptor related genes in pan-cancer. *P ≤ 0.05; **P ≤ 0.01; ***P ≤ 0.001

Additional file 5 of Integrated pancancer analysis reveals the oncogene characteristics and prognostic value of DIP2B in breast cancer

Additional file 5: sFigure 5. The relationship between expression of DIP2B and subtypes of immune infiltration cells in pancancer

Additional file 3 of Integrated pancancer analysis reveals the oncogene characteristics and prognostic value of DIP2B in breast cancer

Additional file 3: sFigure 3. The relationship between expression of DIP2B and tumor stage in 19 cancer types

Additional file 4 of Integrated pancancer analysis reveals the oncogene characteristics and prognostic value of DIP2B in breast cancer

Additional file 4: sFigure 4. The relationship between expression of DIP2B and overall survival in pancancer

DataSheet_2_First-Line Treatments for Extensive-Stage Small-Cell Lung Cancer With Immune Checkpoint Inhibitors Plus Chemotherapy: A Network Meta-Analysis and Cost-Effectiveness Analysis.docx

BackgroundImmune checkpoint inhibitors (ICIs) plus chemotherapy were unlikely to be considered cost-effective compared with chemotherapy as the first-line treatment of patients with extensive-stage small-cell lung cancer (ES-SCLC) in China due to its high costs. However, the cost-effectiveness of the comparison between the regimens of ICIs plus chemotherapy were remained unclear yet. The aim of this study was to evaluate the efficacy and cost-effectiveness of ICIs plus chemotherapy as the first-line treatment for ES-SCLC from the perspective of the Chinese healthcare system.MethodsA network meta-analysis (NMA) was conducted to indirect compare the clinical benefits between the ICIs plus chemotherapy regimens. A decision-analytic model was established to evaluate the cost-effectiveness from the Chinese healthcare system, the clinical efficacy and safety data were obtained from the clinical trials and the results of NMA. Cost and utility values were gathered from the local charges and previously studies. Key outputs of the NMA were overall survival (OS) and progression-free survival (PFS). Incremental cost-effectiveness ratios (ICERs) were estimated. One-way and probabilistic sensitivity analyses were performed to explore the robustness of the model outcomes.ResultsFive clinical trials (IMpower133, CASPIAN, KEYNOTE-604, CA184-156, and EA5161) of 1,255 patients received first-line ICIs plus chemotherapy strategies were analyzed in the NMA. NMA showed that nivolumab plus chemotherapy was ranked higher than other strategies. The cost-effectiveness analysis showed that atezolizumab plus chemotherapy achieved relatively higher health benefits and lower costs. One-way sensitivity analyses revealed that the cost of ICIs had the substantial impact on model outcomes. The probabilistic sensitivity analyses suggested that the probability of atezolizumab plus chemotherapy could be considered cost-effective was more than 50% at the willingness-to-pay (WTP) threshold of $31,313/QALY in China. In scenario analyses, when the price of nivolumab reduced 80%, the probability of nivolumab plus chemotherapy being cost-effective was more than 50%.ConclusionsThe NMA and cost-effectiveness revealed that atezolizumab plus chemotherapy is the most favorable first-line treatment for previously untreated ES-SCLC patients compared other ICIs plus chemotherapy regimens in China. The price reduction of nivolumab would make nivolumab plus chemotherapy be the most cost-effective option in future possible context.</p