Adding atezolizumab to treatment with bevacizumab, carboplatin, and paclitaxel as first-line therapy for metastatic, nonsquamous non-small cell lung cancer (NSCLC) is associated with survival benefit—but it comes at a cost, researchers said in study results published in JAMA Network Open. In comparison, pembrolizumab offers a more cost-effective survival benefit. 

Using a microsimulation model to determine the cost effectiveness of atezolizumab versus pembrolizumab when used in combination with bevacizumab, carboplatin, and paclitaxel, researchers evaluated a control case involving 1,000,000 patients. They found that atezolizumab had a mean cost of $244,166 per patient with mean survival of 2.13 quality-adjusted life years (QALYs), whereas pembrolizumab had a mean cost of $266,282 per patient with a mean 2.45 QALYs. 

The researchers said that the effectiveness ratio for both drugs was still higher than the willingness-to-pay threshold of $100,000 per QALY and that “price reductions remain the most pragmatic solution for the insufficient cost-effectiveness of these PD-1 or PD-L1 immune checkpoint inhibitors in the treatment of metastatic nonsquamous NSCLC.”