Updated pharmacoeconomic analysis of atesolizumab efficiency compared with other PD-1 inhibitors in patients with advanced non-small cell lung cancer after chemotherapy

Objective: to evaluate the pharmacoeconomic efficiency of atezolizumab (inhibitor of programmed death ligand 1 (PD-L1)) in comparison with other checkpoint inhibitors (inhibitors of programmed cell death protein 1 (PD-1)) in patients with advanced non-small cell lung cancer (NSCLC) after previous chemotherapy in the current conditions of the Russian healthcare system.

Material and methods. The study design was a retrospective analysis of publications and modeling. The previously performed pharmacoeconomic study was updated considering a decrease in the cost of pembrolizumab after the generic form was released on the market and actualization of calculated target population. Cost minimization analysis was carried out and the impact on the healthcare system budget was estimated when treating all NSCLC patients provided with PD-1/ PD-L1 inhibitors in the second and third lines of therapy with atezolizumab. For calculations, we used registered prices according to the state register of maximum selling prices and average weighted marginal wholesale markup according to the Federal Antimonopoly Service.

Results. In the cost minimization analysis, atezolizumab showed greater clinical and economic efficiency, its use reduces costs by 28.6% over 3 years compared to nivolumab and by 8.8% compared to pembrolizumab in the second and third lines of NSCLC therapy. The budget impact analysis demonstrated that if all patients in the target group currently receiving various PD-1/PD-L1 inhibitors in the second and third lines of NSCLC therapy were initially provided with atezolizumab, it would reduce the budget load over 3 years by 11.6%, or by 722.4 mln rubles.

Conclusion. The use of atezolizumab is pharmacoeconomically justified and feasible compared to nivolumab and pembrolizumab, even after a release of the generic version of the latter, and will reduce the costs of PD-1/PD-L1 inhibitors in the second and third lines of NSCLC therapy.

1. Kaprin A.D., Starinskiy V.V., Shakhzadova A.O. (Eds.) Malignant neoplasms in Russia in 2022. Мoscow: Herzen Moscow Research Oncological Institute – branch of National Medical Research Center of Radiology; 2022: 239 pp. (in Russ.).

2. Malignant neoplasm of bronchi and lung. Clinical guidelines. 2022. Available at: https://cr.minzdrav.gov.ru/recomend/30_4 (in Russ.) (accessed 03.09.2023).

3. Instructions for the medical use of the drug Keytruda®. Available at: http://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=88450c7624e5-43ee-bbd3-afd10dc1e7c8&t= (in Russ.) (accessed 03.09.2023).

4. Instructions for the medical use of the drug Opdivo® Available at: http://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=f6ac1a6a9f33-4eaa-a603-b2928d720378&t= (in Russ.) (accessed 03.09.2023).

5. Instructions for the medical use of the drug Tecentriq®. Available at: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=c210e8ba5f80-4dc6-90bc-98e51fb468ed&t= (in Russ.) (accessed 03.09.2023).

6. Zyryanov S.K., Diyakov I.N. Pharmacoeconomic efficacy of atesolizumab compared with other PD-1 inhibitors in patients with advanced non-small cell lung cancer after chemotherapy. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya / FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2020; 13 (1): 5–12. https://doi.org/10.17749/2070-4909.2020.13.1.5-12.

7. Créquit P., Chaimani A., Yavchitz A., et al. Comparative efficacy and safety of second-line treatments for advanced non-small cell lung cancer with wild-type or unknown status for epidermal growth factor receptor: a systematic review and network meta-analysis. BMC Med. 2017; 15 (1): 193. https://doi.org/10.1186/s12916-0170954-x.

8. Rittmeyer A., Barlesi F., Waterkamp D., et al. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. Lancet. 2017; 389 (10066): 255–65. https://doi.org/10.1016/S01406736(16)32517-X.

9. Blokhin National Medical Research Center of Oncology. Price list. Available at: https://www.ronc.ru/platnye-uslugi/prays-list-uslug/ (in Russ.) (accessed 03.09.2023).

10. Decree of the Government of the RF of 28.08.2014 No. 871 “On approval of the Rules for the formation of lists of medicines for medical use and the minimum range of medicines necessary for the provision of medical care”. Available at: https://base.garant.ru/70728348/ (in Russ.) (accessed 03.09.2023).