Atezolizumab对于晚期非小细胞肺癌（NSCLC）患者可能提供临床益处。然而，atezolizumab的价格相对较高，其经济效益还不清楚。本研究使用两个模型来评估中国医疗保健系统中以初始单剂atezolizumab为疗法和以化疗为疗法的PD-L1高表达EGFR和ALK野生型晚期NSCLC患者的成本效益。使用分段生存模型和Markov模型评估以PD-L1高表达EGFR和ALK野生型疾病为特点的晚期NSCLC患者中一线单剂atezolizumab与铂类化疗的成本效益。临床结果和安全信息来自IMpower110试验的最新数据，而成本和效用值来自中国医院和相关文献。估计了总成本、寿命年数（LYs）、经济效益调整后的寿命年数（QALYs）和增量成本效益比（ICER）。进行了单向和概率敏感性分析以探索模型的不确定性。还针对“患者援助计划（PAP）”和中国各省进行了情景分析。在分段生存模型中，atezolizumab的总成本为145,038美元，提供2.92 LYs和2.39 QALYs，而化疗的总成本为69,803美元，提供2.12 LYs和1.65 QALYs。atezolizumab与化疗相比的ICER为102,424.83美元/QALY；在Markov模型中，ICER为104,806.71美元/QALY。以三倍中国人均国内生产总值（GDP）的WTP阈值为标准，atezolizumab并不划算。敏感性分析显示，atezolizumab的成本、PFS的效用和折现率对ICER有显著影响；患者援助计划显著降低了ICER，但在中国，atezolizumab仍然不划算。一线的单剂atezolizumab对于PD-L1高表达EGFR和ALK野生型晚期NSCLC患者而言，根据中国医疗保健系统来看, 在成本效益方面比化疗更没有优势; 提供PAP会提高atezolizumab的成本效益。在中国经济发达程度较高的地区，atezolizumab可能是划算的。要改善atezolizumab的成本效益，需要降低药品价格。版权所有©2023 Zhang, Liu, Tan, Tian and Li。

Atezolizumab may provide clinical benefits to patients with advanced non-small cell lung cancer (NSCLC). However, the price of atezolizumab is relatively high, and its economic outcomes have remained unclear. In this study, we used two models to examine the cost-effectiveness of initial atezolizumab monotherapy versus chemotherapy for patients with PD-L1 high-expressing EGFR and ALK wild-type advanced NSCLC in the context of the Chinese healthcare system.Partitioned Survival model and Markov model were performed to evaluate the cost-effectiveness of first-line single-agent atezolizumab versus platinum-based chemotherapy for patients with advanced NSCLC with PD-L1 high-expressing EGFR and ALK wild-type disease. Clinical outcomes and safety information were obtained from the most recent data from the IMpower110 trial, while cost and utility values were obtained from Chinese hospitals and relevant literature. Total costs, life years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated. One-way and probabilistic sensitivity analyses were performed to explore model uncertainty. Scenario analyses were also conducted for the Patient Assistance Program (PAP) and various provinces in China.In the Partitioned Survival model, the total cost of atezolizumab was $145,038, providing 2.92 LYs and 2.39 QALYs, while the total cost of chemotherapy was $69,803, providing 2.12 LYs and 1.65 QALYs. The ICER for atezolizumab versus chemotherapy was $102,424.83/QALY; in the Markov model, the ICER was $104,806.71/QALY. Atezolizumab was not cost-effective at the WTP threshold of three times China's per capita gross domestic product (GDP). Sensitivity analysis showed that the cost of atezolizumab, the utility of PFS, and the discount rate had a significant impact on ICER; PAP significantly reduced ICER, but atezolizumab was still not cost-effective in China.First-line monotherapy with atezolizumab for patients with PD-L1 high-expressing EGFR and ALK wild-type advanced NSCLC was estimated to be less cost-effective than chemotherapy in terms of the Chinese healthcare system; offering PAP increased the likelihood that atezolizumab would be cost-effective. In some areas of China with higher levels of economic development, atezolizumab was likely to be cost-effective. To improve the cost-effectiveness of atezolizumab, drug prices would need to be reduced.Copyright © 2023 Zhang, Liu, Tan, Tian and Li.