A cost–utility analysis of atezolizumab in the second-line treatment of patients with metastatic bladder cancer

  • A. Parmar Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto
  • M. Richardson University of Toronto
  • P. C. Coyte University of Toronto, University Health Network
  • S. Cheng Odette Cancer Centre, Sunnybrook Health Sciences Centre
  • B. Sander University of Toronto, University Health Network, Public Health Ontario
  • K.K.W. Chan Odette Cancer Centre, Sunnybrook Health Sciences Centre
Keywords: Cost-Utility Analysis, Health Technology Assessment, Atezolizumab, Immunotherapy, Metastatic Bladder Cancer

Abstract

Background Despite initial promising results, the IMvigor211 clinical trial failed to demonstrate an overall sur­vival (os) benefit for atezolizumab compared with chemotherapy in the second-line treatment of metastatic bladder cancer (mbc). However, given  lessened adverse events (aes) and preserved quality of life (qol) with atezolizumab, there might still be investment value. To evaluate that potential value, we conducted a cost–utility analysis (cua) of atezolizumab compared with chemotherapy from the perspective of the Canadian health care payer.

Methods A partitioned survival analysis model was used to evaluate atezolizumab compared with chemotherapy over a lifetime horizon (5 years). The base-case analysis was conducted for the intention-to-treat (itt) population, with additional scenario analyses for subgroups by IMvigor-defined PD-L1 status. Effectiveness was evaluated through life–year gains and quality-adjusted life–years (qalys). Cost estimates in 2018 Canadian dollars for systemic treatment, aes, and end-of-life care were incorporated. The incremental cost-effectiveness ratio (icer) was used to compare treatment strategies. Parameter and model uncertainty were assessed through sensitivity and scenario analyses. Per Canadian guidelines, cost and effectiveness were discounted at 1.5%.

Results For the itt population, the expected qalys for atezolizumab and chemotherapy were 0.75 and 0.56, with expected costs of $90,290 and $8,466 respectively. The resultant icer for atezolizumab compared with chemotherapy was $430,652 per qaly. Scenario analysis of patients with PD-L1–positive tumours led to a lower icer ($334,387 per qaly). Scenario analysis of observed compared with expected benefits demonstrated a higher icer, with a shorter time horizon ($928,950 per qaly).

Conclusions Despite lessened aes and preserved qol, atezolizumab is not considered cost-effective for the second-line treatment of mbc.


Author Biographies

A. Parmar, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto

Institute of Health Policy, Management and Evaluative Sciences

M. Richardson, University of Toronto

Institute of Health Policy, Management and Evaluative Sciences

P. C. Coyte, University of Toronto, University Health Network

Institute of Health Policy, Management and Evaluative Sciences, Toronto Health Economics and Technology
Assessment Collaboration

B. Sander, University of Toronto, University Health Network, Public Health Ontario

Institute of Health Policy, Management and Evaluative Sciences, Toronto Health Economics and Technology
Assessment Collaboration, Institute of Clinical Evaluative Sciences

K.K.W. Chan, Odette Cancer Centre, Sunnybrook Health Sciences Centre

Institute of Health Policy, Management and Evaluative Sciences, Canadian Centre for Applied Research in
Cancer Control

Published
2020-04-11
How to Cite
Parmar, A., Richardson, M., Coyte, P. C., Cheng, S., Sander, B., & Chan, K. (2020). A cost–utility analysis of atezolizumab in the second-line treatment of patients with metastatic bladder cancer. Current Oncology, 27(4). https://doi.org/10.3747/co.27.5459
Section
Medical Economics