<p>Economic Evaluations of Immune Checkpoint Inhibitors for Patients with Non-Small Cell Lung Cancer: A Systematic Review</p>

Abstract

This review aimed to assess the quality of available evidence on the economic evaluations of immune checkpoint inhibitors in patients with non-small cell lung cancer (NSCLC) and provide evidence to improve the efficiency of healthcare resources. Materials and Methods: Literature search was performed using some electronic databases (PubMed, Embase and Cochrane Central Register of Controlled Trials). Final search was performed in December 2019. Study characteristics and results were recorded and compared. The quality of the studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklists. We did not elaborate the restrictions on the target population. We included patients with squamous or non-squamous NSCLC and metastatic or advanced cancer. Results: Of 98 papers considered, 21 were chosen for this review. Most of them are costeffectiveness analysis. Comparative regimens consisted of either immune checkpoint inhibitor monotherapy, immune checkpoint inhibitor plus chemotherapy, or chemotherapy alone. Fourteen, four, and three studies were about pembrolizumab, nivolumab, and atezolizumab, respectively. The methods mostly used in these studies were modeling and sensitivity analysis. All studies used quality-adjusted life year (QALY) and life years (LY) as outcomes. Most studies were conducted in high-income countries. Based on the willingness to pay threshold, atezolizumab, and pembrolizumab were found to be cost-effective in one and 10 studies, respectively. None of the studies concluded that nivolumab was cost-effective. For quality assessment, all studies fulfilled more than 50% of the CHEERS checklist. Conclusion: The included studies indicated that pembrolizumab regimens are cost-effective as first-line treatment for patients with NSCLC in developed countries. Nivolumab and atezolizumab are likely to be cost-effective as second-line treatment but not as first-line treatment.

Cost-Utility Analysis of Camrelizumab Plus Chemotherapy Versus Chemotherapy Alone as a First-Line Treatment for Advanced Nonsquamous Non-Small Cell Lung Cancer in China

“…Our results are consistent with that of another study based on the same clinical trial (11). And the conclusion is consistent with the systematic review, which showed that ICIs as a first-line treatment for NSCLC has no economic advantage versus chemotherapy regardless of PD-L1 level, but they may be economic in developed countries (12). Of course, the WTP varies from country to country.…”

“…Although the success of breaking through the two-year mark will bring good survival benefits to patients, high prices may bring a heavy socioeconomic burden to patients and the healthcare system. There is no uniform conclusion about its economic impact at present (10,11), and the systematic review showed that checkpoint inhibitors as a first-line treatment for NSCLC has no economic advantage versus conventional chemotherapy regardless of PD-L1 level (12). Therefore, a cost-utility evaluation was performed to compare camrelizumab plus standard chemotherapy with standard chemotherapy alone as a first-line treatment for advanced nonsquamous NSCLC from the perspective of the Chinese health care system in this study.…”

Cost-effectiveness of Nivolumab-Ipilimumab Combination Therapy for the Treatment of Advanced Non–Small Cell Lung Cancer

“…The CheckMate 227 clinical trial stratified patients by PD-L1 expression level (≥1% or <1%) and randomized patients to receive chemotherapy alone, nivolumab therapy with or without chemotherapy (depending on PD-L1 level), or nivolumab-ipilimumab combination therapy. Given that the cost-effectiveness of mono–checkpoint inhibition among patients with advanced NSCLC has been evaluated elsewhere, 15 , 16 , 17 we sought to assess the cost-effectiveness of dual checkpoint inhibition with nivolumab-ipilimumab combination therapy compared with chemotherapy. Our primary cost-effectiveness analysis used all patient data from the CheckMate 227 clinical trial (regardless of PD-L1 status).…”

New benzenesulphonohydrazide derivatives as potential antitumour agents

“…In 2018, >1.7 million cancer deaths worldwide were caused by lung cancer that remains the most common cancer (11.6% of all cancers) and the main cause of cancer-related deaths (1). In USA in 2018, the number of lung cancer-related deaths exceeded the combined number of deaths caused by the most common cancers (breast, colon and prostate) (2).…”

“…The majority of neoplasms developing in the lungs are pathologically categorized as non-small cell lung cancer (NSCLC) and further divided into the following subtypes: Adenocarcinoma, large cell carcinoma and squamous cell carcinoma (SCC). Epidemiological data have demonstrated that ~20% of NSCLC cases are diagnosed as SCC (1). It has been demonstrated that SCC is associated with chronic tobacco exposure (3).…”