Abstract
BACKGROUND: Patients with early-stage non-small-cell lung cancer (eNSCLC) often experience disease recurrence after surgery and adjuvant chemotherapy, leading to a substantial clinical and economic burden. The introduction of immunotherapy such as atezolizumab in the adjuvant setting may offer both clinical benefits and healthcare cost reductions by preventing disease progression. OBJECTIVES: This analysis aimed to estimate the economic impact of prevented recurrences by measuring the costs avoided in the Italian population potentially eligible for adjuvant atezolizumab. METHODS: A cost-consequence analysis was developed using a published model, adapted to the Italian context, to estimate the number of recurrences per year from 2023 to 2033, comparing scenarios 'with' and 'without' atezolizumab. Epidemiological and clinical input was obtained from published literature, clinical trials, and local market research. Direct healthcare costs were sourced from an Italian real-world study. The Italian national health system (NHS) perspective was considered, and a deterministic one-way sensitivity analysis was performed to evaluate the uncertainty over the main parameters. RESULTS: Over the period considered, 2582 patients with stage II-IIIA eNSCLC (7th edition of the TNM [tumour, node, metastases] classification) after resection and chemotherapy were estimated annually. Of these, 720 (27.9%) were potentially eligible to receive atezolizumab according to the approved indication. Overall, the model estimated 2556 recurrences for the eligible patients, which generated an economic burden of €11.02 million yearly. The introduction of atezolizumab could avoid 720 recurrences (111 locoregional and 609 metastatic), resulting in a direct healthcare cost reduction of €3.11 million annually from the perspective of the Italian NHS. One-way sensitivity analysis showed moderate base-case changes, especially due to drug costs in the metastatic settings. CONCLUSIONS: Recurrences are common among patients with eNSCLC and are associated with a remarkable increase in total direct costs. It appears that adjuvant atezolizumab would prevent a relevant number of events, with potential savings in recurrence-related costs from the perspective of the NHS in Italy.