Cost-Effectiveness of Pembrolizumab for The First-Line Treatment of Metastatic Non-Small Cell Lung Carcinoma in Portugal

Abstract

Objectives: The objective of this study was to assess the cost-effectiveness of nivolumab in combination with ipilimumab (Nivo+Ipi) as first line advanced melanoma treatment across 3 European countries. MethOds: A cost-effectiveness model, using a three-state partitioned survival structure was developed. The model utilised the intent-to-treat 28-month progression-free survival data and overall survival data from the CheckMate 067 trial and a network meta-analysis which considers time-varying hazard ratios. The model utilised inputs for Greece, Spain and Portugal. The model considered a 30 year time horizon. Drug acquisition, administration, follow-up, subsequent therapy and adverse event costs were obtained via published unit prices and expert input on resource utilization. Adverse event frequencies were derived from the CheckMate 067 trial and published literature. Utility weights were also estimated from the trial, based on UK tariffs. The key comparators included in the analysis are nivolumab and ipilimumab monotherapy, however an additional comparison with pembrolizumab was considered in sensitivity analysis. Results: The incremental cost per quality adjusted life years (QALY) ratios (ICUR) were consistent across the three countries. Nivo+ Ipi had an ICUR ranging from

Modeling Challenges in Cost-Effectiveness Analysis of First-Line Immuno-Oncology Therapies in Non-small Cell Lung Cancer: A Systematic Literature Review

“…Upon full-text screening, 27 articles identified through database searches ultimately met the inclusion criteria, with an additional 19 records (three conference abstracts, one full-text publication, and 15 TAs) identified through other sources or bibliography checks. In total, 46 records on economic models (18 full texts [9][10][11][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], 13 conference abstracts [28][29][30][31][32][33][34][35][36][37][38][39][40], and 15 TAs [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55]) met eligibility criteria and were ultimately included in the review (see Fig. 1).…”

“…When summarizing our findings, we covered 26 publications comprising 38 unique models (15 full texts [10, 11, 13-15, 17-20, 22-27], 11 conference abstracts [28][29][30][31][32][35][36][37][38][39][40], and 12 TAs [41-45, 48-51, 53-55]) and discussed adaptations only when explicitly mentioned.…”

“…Of the unique models, most were of a European (including the UK) perspective. Model populations were similar across CEAs; almost two-thirds of models were in patients with metastatic NSCLC only [ 10 , 11 , 14 , 17 – 19 , 23 , 24 , 26 , 28 – 30 , 35 – 38 , 40 ], whereas more than one-third included patients with advanced or metastatic disease [ 13 , 15 , 20 , 22 , 25 , 27 , 31 , 32 , 39 ]. All 38 models compared the cost effectiveness of IOs (atezolizumab, nivolumab, and pembrolizumab, alone or in combination with other treatments) against standard chemotherapy; eight models [ 11 , 14 , 18 , 19 , 29 , 41 , 43 , 49 ] included more than one IO strategy, of which three [ 11 , 14 , 29 ] concerned different IOs (Fig.…”

“…None of the models published as full-text studies carried out adjustments for treatment switching in the base case, although one explored this adjustment in a scenario analysis [ 17 ]. Another abstract [ 38 ] mentioned applying an adjustment in the base-case analysis. It was somewhat more common for models included in TAs to adjust for treatment switching.…”

“…Two approaches in modeling health utilities were found. A total of 15 studies [ 10 , 13 , 15 , 20 , 22 – 28 , 40 , 48 – 50 ] modeled utilities by health status (i.e., progression free vs. progressed), whereas another four studies [ 11 , 18 , 19 , 38 ] applied the time-to-death approach. Ten studies [ 17 , 41 – 45 , 51 , 53 – 55 ] explored both.…”