Abstract
BackgroundImmune checkpoint inhibitors (ICIs) for treatment of non-small cell lung cancer (NSCLC) have been rapidly evolving. ICIs are likely to be more effective but also lead to escalating healthcare costs.ObjectivesThe aim of this study was to evaluate the cost effectiveness of immune checkpoint inhibitors (ICIs) for treatment of non-small cell lung cancer (NSCLC).MethodsWe searched the PubMed, Web of Science, and Cochrane Library for studies comparing the cost effectiveness of ICIs for NSCLC. Potential studies identified were independently checked for eligibility by two authors, with disagreement resolved by a third reviewer. Quality of the included studies was evaluated using Consolidated Health Economic Evaluation Reporting Standards checklists.ResultsA total of 22 economic studies were included. Overall reporting of the identified studies largely met CHEERS recommendations. In the first-line setting, for advanced or metastatic NSCLC patients with PD-L1 ≥ 50%, pembrolizumab appeared cost-effective compared with platinum-based chemotherapy in the US and Hong Kong (China), but not in the UK and China. The cost-effectiveness of pembrolizumab versus chemotherapy for first-line treatment of NSCLC in PD-L1 ≥ 1% patients remained obscure. Regardless of PD-L1 expression status, pembrolizumab in combination with chemotherapy could be a cost-effective first-line therapy in the US. On the contrary, addition of atezolizumab to the combination of bevacizumab and chemotherapy was not cost-effective for patients with metastatic non-squamous NSCLC from the US payer perspective. In the second-line setting compared with docetaxel, pembrolizumab was cost-effective; though nivolumab was not cost-effective in the base case, it could be by increased PD-L1 threshold. Results of the cost-effectiveness of atezolizumab second-line treatment remained inconsistent. In addition, the adoption of durvalumab consolidation therapy after chemoradiotherapy could be cost-effective versus no consolidation therapy for patients with stage III NSCLC.ConclusionsImmunotherapy can be a cost-effective option for treatment of NSCLC in several scenarios. A discount of the agents or the use of PD-L1 expression as a biomarker improves the cost-effectiveness of immunotherapy.
Highlights
Lung cancer is the most common cancer and the leading cause of cancer mortality worldwide, with an estimated incidence of more than 2 million cases and approximately 1.8 million deaths [1]
In the second-line setting compared with docetaxel, pembrolizumab was cost-effective; though nivolumab was not cost-effective in the base case, it could be by increased programmed death ligand 1 (PD-L1) threshold
A discount of the agents or the use of PD-L1 expression as a biomarker improves the costeffectiveness of immunotherapy
Summary
Lung cancer is the most common cancer and the leading cause of cancer mortality worldwide, with an estimated incidence of more than 2 million cases and approximately 1.8 million deaths [1]. Non-small cell lung cancer (NSCLC) accounts for 80–90% of lung cancer. Up to approximately 55% of cases are diagnosed at a metastatic stage, which leads to poor long-term prognosis [2]. The recent introduction of immune checkpoint inhibitors (ICIs), namely monoclonal antibodies directed against programmed death receptor 1 (PD-1), programmed death ligand 1 (PD-L1) and cytotoxic T-cell lymphocyte antigen-4 (CTLA-4) monoclonal antibodies, has resulted in an increase in overall survival (OS) rates of patients with advanced NSCLC on the basis of numerous clinical trials [4,5,6,7,8,9,10]. Immune checkpoint inhibitors (ICIs) for treatment of non-small cell lung cancer (NSCLC) have been rapidly evolving. ICIs are likely to be more effective and lead to escalating healthcare costs
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