Economic evaluation of therapeutic cancer vaccines and immunotherapy: A systematic review

Abstract

Cancer immunotherapy is a rapidly growing field in oncology. One attractive feature of cancer immunotherapy is the purported combination of minimal toxicity and durable responses. However such treatments are often very expensive. Given the wide-spread concern over rising health care costs, it is important for all stakeholders to be wellinformed on the cost and cost-effectiveness of cancer immunotherapies. We performed a comprehensive literature review of cost and cost-effectiveness research on therapeutic cancer vaccines and monoclonal antibodies, to better understand the economic impacts of these treatments. We summarized our literature searches into three tables by types of papers: systematic review of economic studies of a specific agent, cost and cost-effectiveness analysis. Our review showed that out of the sixteen immunotherapy agents approved, nine had relevant published economic studies. Five out of the nine studied immunotherapy agents had been covered in systematic reviews. Among those, only one (rituximab for non-Hodgkin lymphoma) was found to be costeffective. Of the four immunotherapy drugs not covered in systematic reviews (alemtuzumab, ipilimumab, sipuleucel-T, ofatumumab), high incremental cost-effectiveness ratio (ICER) was reported for each. Many immunotherapies have not had economic evaluations, and those that have been studied show high ICERs or frank lack of cost-effectiveness. One major hurdle in improving the cost-effectiveness of cancer immunotherapies is to identify predictive biomarkers for selecting appropriate patients as recipients of these expensive therapies. We discuss the implications surrounding the economic factors involved in cancer immunotherapies and suggest that further research on cost and costeffectiveness of newer cancer vaccines and immunotherapies are warranted as this is a rapidly growing field with many new drugs on the horizon.

Identification of a HLA-A*0201-restricted immunogenic epitope from the universal tumor antigen DEPDC1

“…Despite this evidence, the identification of expressed nonsynonymous somatic mutations by whole-exome sequencing of tumor and normal DNA, which allows the selection of candidate neoepitopes to be exploited for developing personalized immunotherapies, is typically unwieldy, time-consuming and expensive. 8 To overcome the practical limitations of personalized cancer immunotherapy, the identification of universal tumor-specific antigens (TSA) shared between multiple patients and/or multiple tumors has been gaining renewed interest and great importance. Furthermore, the selection of TSAs playing a key role in tumor cell proliferation and survival is considered crucial to overcome immune escape, as their downregulation or loss is expected to impair tumor progression.…”

Nucleic Acid Nanoparticles at a Crossroads of Vaccines and Immunotherapies

“…There is an increased interest in so-called therapeutic vaccines, which aim at inducing the antigen-specific cytotoxic T-lymphocytes. These vaccines are of particular importance to cancer therapy [18][19][20].…”

Molecular Imaging of Immunotherapy Targets in Cancer

“…Molecular imaging can provide nearly real-time information about receptor expression levels, allowing physicians to predict which patients may benefit from immunotherapy and accounting for response differences between individual patients. In return, these prescreening measures will not only spare patients ineffective therapy and potential adverse effects, but will also have implications economically as cancer therapy remains costly and time-intensive (6). In addition to patient stratification, molecular imaging of immunotherapy targets may provide insight into the status of the immune system and overall disease progression.…”