Ανάλυση κόστους - αποτελεσματικότητας του Atezolizumab σε συνδυασμό με χημειοθεραπεία σε εκτεταμένου σταδίου μικροκυτταρικό καρκίνο του πνεύμονα

Χαβιάρα, Έφη

Cost effectiveness analysis of Atezolizumab plus chemotherapy in extensive - stage small - cell lung cancer

Master Thesis

Author

Χαβιάρα, Έφη

Date

2021

Abstract

Lung cancer is the leading cause of cancer death worldwide. About 80% of cases are non-small cell lung cancer (NSCLC) and 20% are small cell lung cancer (SCLC) which is the fastest growing cancer. Small cell lung cancer is divided into 2 stages – limited and extensive but at the time of diagnosis about 30% with small cell carcinoma are of limited stage. In the case of limited stage, 50-60% complete response is achieved with an average survival of 15-24 months with chemotherapy. In extended disease the complete response is <20% with an average survival of 6-12 months with chemotherapy, but long survival is rare. According to the IMpower133 clinical study, overall survival was significantly longer in the atezolizumab group (median, 12.3 months; 95% confidence interval [CI], 10.8 to 15.9) than in the placebo group (median, 10.3 months; 95% CI, 9.3 to 11.3). Progression free survival was higher in the atezolizumab group (median 5.2 months, 95% CI, 4.4 to 5.6) than in the placebo group (median 4.3 months, 95% CI, 4.2 to 4.5). Atezolizumab is an Fc-engineered, humanised immunoglobulin G1 (IgG1) monoclonal antibody that directly binds to PD-L1 and provides a dual blockade of the PD-1 and B7.1 receptors, releasing PD-L1/PD-1 mediated inhibition of the immune response, including reactivating the antitumour immune response without inducing antibody-dependent cellular cytotoxicity. Atezolizumab spares the PD-L2/PD-1 interaction allowing PD-L2/PD-1 mediated inhibitory signals to persist. European Medicines Agency (EMA), issued a Marketing Authorization for Tecentriq on 21st September 2017 and on 26th July 2019, the Marketing Authorization was extended for the treatment of first-line adult patients with extended stage small cell lung cancer. Objective. The purpose of this analysis is to assess the cost effectiveness of Atezolizumab (Tecentrriq) compared to the simple combination (carboplatin and etoposide) as a first-line treatment for adult patients with extended stage small cell lung cancer (ES-SCLC). Method. The analysis uses a Markov model which comprised of three health states: "Progression Free Survival (PFS)", "Progressed Disease (PD)" and "death". The model follows patients over time from the start of therapy till death using weekly cycles. The probabilities for OS and PFS were extracted from the reference clinical trial Impower133 and were extrapolated to a period of 5 years time horizon (lifetime analysis). Costs and health outcomes are discounted at 3.5% annually as recommended by NICE (UK) as for Greece there are no relevant guidelines. Results. The combination of atezolizumab / carboplatin / etoposide compared with placebo / carboplatin / etoposide for the first-line treatment of adult patients with advanced small cell lung cancer was more costly per patient but at the same time life expectancy (LYs) and quality of life (QALYs) were improved. The ICER was estimated at € 118,108.68 / QALY and € 61,527.03 / LYG for the life expectancy of these patients. Sensitivity analysis showed that the results are sensitive to the cost of Atezolizumab but not sensitive to the discount rate. Conclusions. According to the results of the present study, the combination of atezolizumab / carboplatin / etoposide in comparison with the standard chemotherapy (carboplatin / etoposide) seems to be under conditions a cost-effective treatment option for the National Health System of Greece.

Postgraduate Studies Programme

Οικονομικά και Διοίκηση της Υγείας

Department

Σχολή Οικονομικών, Επιχειρηματικών και Διεθνών Σπουδών. Τμήμα Οικονομικής Επιστήμης

Number of pages

144

Language

Greek

URI

https://dione.lib.unipi.gr/xmlui/handle/unipi/13682
http://dx.doi.org/10.26267/unipi_dione/1105

Collections

Τμήμα Οικονομικής Επιστήμης

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Except where otherwise noted, this item's license is described as
Αναφορά Δημιουργού-Μη Εμπορική Χρήση-Όχι Παράγωγα Έργα 3.0 Ελλάδα