ESTIMATING RECURRENCES PREVENTED AND COSTS AVOIDED WITH ATEZOLIZUMAB IN EARLY NON-SMALL CELL LUNG CANCER UNDER THE BRAZILIAN SUPPLEMENTARY HEALTH SYSTEM PERSPECTIVE

Introduction: About half of the patients with non-small cell lung cancer (NSCLC) are diagnosed at resectable stages of the disease (stage I-III) and the treatment of choice is curative surgery. However, post-resection recurrences are frequent, with approximately 45% of patients having recurrence within 5 years. In the real world, the use of adjuvant chemotherapy treatment ranges from 40 to 60% and the overall survival in 5 years for patients with recurrence after surgical resection and adjuvant chemotherapy is 35.6%. Therefore, effective and well-tolerated treatments are important. OBJECTIVES: To estimate the clinical and economic impact of the use of atezolizumab (ATZ) as an adjuvant immunotherapy in the Brazilian Supplementary Healthcare System (SHS). Methods: We estimated the number of recurrences avoided, deaths avoided and costs avoided using ATZ as an adjuvant treatment after resection and platinum-based chemotherapy (IMpower 010 study) for adults with resected stage II to IIIA (AJCC TNM 7th edition) ALK/EGFR-positive or negative early NSCLC with PD-L1 expression of ≥1% who received adjuvant chemotherapy, under the perspective of the SHS. A Monte Carlo simulation model was used to estimate the cumulative number of recurrences and deaths prevented by treating eligible eNSCLC patients with ATZ compared with best supportive care (BSC). The model included a cohort of patients treated for one year and then followed over a five-year time horizon. Results: We estimated 406 patients eligible for treatment in the SHS in Brazil. Of these patients, an estimated 223 (95% CI: 222, 224) patients would have a recurrence within 5 years after receiving BSC. Following the introduction of ATZ, 105 (95% CI: 106, 104) recurrences and 37 (95% CI: 38, 36) deaths would be avoided over the 5-year time horizon. Among these recurrences avoided, 43 (95% CI: 43, 42) would be distant, and 23 (95% CI: 23, 23) would be locoregional and distant recurrences. The recurrence and death events avoided with ATZ were associated with cumulative direct medical cost savings of R$65.8 million (95% CI: R$66.1 million, R$65.4 million) over 5 years, with the greatest savings observed in pharmacy costs (~R$53.7 million). Conclusion: Adjuvant treatment with atezolizumab reduced the disease recurrence, deaths, and associated costs. Thus, treatment with atezolizumab represents a therapeutic option that reduces the burden of disease for this population in the Brazilian Supplementary Health System.