Clinical And Cost Efficacy Of Immunotherapy As A First Line Of Treatment Of Nonsquamous Metastatic Non-Small-Cell Lung Cancer

Abstract

The aim of the study was to model ling local data on costs and health benefits of alternative immunotherapies for first-line treatment of patients with non-squamous metastatic non-small cell lung cancer (ncqNSCLS) and to make an indirect comparison of their health cost ratios and benefits based on network meta-analysis. The inputs data for the model were measured and evaluated clinical endpoints in the randomized multicentre clinical trials IM power 130, KEYNOTE 189, and Check Mate 026. Modelling data for future health benefits and costs after the end of clinical trials using Markov model had three health states, one of which is an absorbent condition. Tree Age Pro Healthcare software was used to modelling the data. Atezolizumab in combination with chemotherapy (nab-paclitaxel, carboplatin) is a cost-effective first-line therapy for patients with nsqNSCLC compared to pembrolizumab in combination with chemotherapy (pemetrexed, carboplatin) and nivolumab immunotherapy alone. A probabilistic susceptibility analysis found that the probability of atezolizumab in combination with chemotherapy being a cost-effective therapy compared to pembrolizumab in combination with chemotherapy and compared to nivolumab monotherapy was 88% and 75%, respectively. Modelling data on health benefits and costs after the end of clinical trials creates some uncertainty about therapeutic efficacy and safety in the long-term monitoring.