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Result of deterministic sensitivity analysis. The top 10 parameters most relevant to ICERs are displayed. AEs, adverse events; BSC, best supportive care; FDP, first disease progression; GP, gemcitabine plus platinum; ICER, incremental cost‐effectiveness ratios; PFS, progression‐free survival; QALY, quality‐adjusted life‐years; WTP, willingness‐to‐pay.
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Background:
Programmed cell death protein-1/programmed cell death ligand-1 (PD-1/L1) inhibitor is a promising therapeutic option that can be used as either a first-line or second-line treatment for driver-negative advanced or metastatic squamous non-small cell lung cancers (sqNSCLC). However, reuse of PD-1/L1 inhibitor in second-line beyond progre...
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Background
Stereotactic body radiotherapy (SBRT) is a novel radio-therapeutic technique that has recently emerged as standard-of-care treatment for medically inoperable, early-stage non-small cell lung cancer (NSCLC). In this study, we compared the cost-effectiveness of SBRT with that of conventional fractionated radiotherapy (CFRT) in patients wit...
Citations
... The exclusion reasons were full text not available. Finally, 15 articles [33,[43][44][45][46][47][48][49][50][51][52][53][54][55][56] were included in this systematic review (Fig. 1). ...
... Results from Cheng 2022 [45] showed that sintilimab retained for second-line use had a higher efficacy and medical cost than first-line treatment (US $12,203 vs. US $14,045), with a corresponding ICER of $12,693 /QALY, which was cost-effective. Compared with pembrolizumab plus chemotherapy, sintilimab combined chemotherapy also been confirmed by Chen 2022 [44] as a lower lifetime cost, fewer QALYs cost-effective option, with ICER of $1,314,208/QALY. ...
Background
There are differences in the pharmacoeconomics of Immune checkpoint blocking (ICB) therapies for the treatment of lung squamous cell carcinoma (LSCC). However, no corresponding review studies have fully discussed the cost-effectiveness of ICBs in treating LSCC. The aim of this paper is to systematically review and evaluate all available pharmacoeconomic studies of ICBs for LSCC.
Method
The inclusion criteria were based on the population, intervention, comparator, outcomes, and study designs. An electronic search was conducted by June 2023, and the following databases were used: PubMed, EMBASE, Cochrane Library, and Web of Science. Search keywords included ‘Carcinoma’, Non-Small-Cell Lung’, ‘Immunotherapy’, and ‘Economics, Medical’. The primary outcome was the cost-effectiveness analysis of ICB therapy in LSCC patients. Drummond Checklist was used to assess quality problems and possible bias in the study design of included pharmacoeconomic studies.
Results
This review searched 15 articles on the economic evaluation of ICB treatment for LSCC. After a qualitative review of 15 studies, we concluded that nivolumab is more cost-effective as a monotherapy than chemotherapy alone. In the combination regimen, pembrolizumab combined with chemotherapy appears to be the most cost-effective option at present, but for Chinese payers with LSCC, locally developed treatments such as sintilimab or toripalimab in combination with chemotherapy are more cost-effective.
Discussion
The inclusion of economic evaluation has heterogeneity in research design and outcomes, which can only support qualitative synthesis. Therefore, The results of this paper need to be treated with caution. For the Chinese market, instead of imported drugs, the possible cost-effectiveness of locally developed ICB therapies should be the focus of future research.
... This expansion of treatment options has increased patient satisfaction and met the demand for cancer medications. [16][17][18] Details of the time of approval, indications, and other relevant information were provided in Table S2. ...
Objectives
The use of immune checkpoint inhibitors, particularly PD‐1 inhibitors, has revolutionized the treatment of advanced tumors and shown significant improvements in patient survival rates. However, which PD‐1 inhibitor is more effective and safer for a specific indication remains unclear. To address this problem, our study aimed to evaluate the effectiveness and safety of different PD‐1 inhibitors in combination with chemotherapy as first‐line therapy for individuals with advanced non‐small‐cell lung cancer (NSCLC) without driver genes in the real world.
Materials and Methods
We conducted a retrospective study of individuals diagnosed with aNSCLC who received immune checkpoint inhibitors (ICIs) with modified PD‐1 inhibitors, including Sintilimab, Toripalimab, Tislelizumab, Camrelizumab, or Pembrolizumab as first‐line treatment between March 5th, 2016 and October 20th, 2022. We assessed demographic and clinical information and analyzed clinical response, survival outcomes, and safety profiles. The primary endpoint was overall survival (OS), and the secondary endpoints included progression‐free survival (PFS), objective response rate (ORR), disease control rate (DCR), and safety.
Results
As of the date cut‐off on October 20th, 2022, the median follow‐up time was 20.62 months. A total of 204 patients were enrolled in the study, including 56 (27.5%) patients receiving modified PD‐1 inhibitors (Sintilimab, Toripalimab, Tislelizumab, or Camrelizumab) in combination with chemotherapy and 148 (72.5%) patients receiving Pembrolizumab in combination with chemotherapy. In the overall cohort, the median overall survival (OS) was 26.9 months (95%CI, 22.3–31.6), the median progression‐free survival (PFS) was 8.4 months (95%CI, 6.9–9.8), and the objective response rate (ORR) and disease control rate (DCR) were 47.6% (95%CI, 29.9–43.6) and 84.3% (95%CI, 78.4–88.9). The mOS of modified PD‐1 inhibitors group and Pembrolizumab group were 30.7 (95%CI, 17.3–44.4) months and 26.8 (95%CI, 22.2–31.4) months. The mPFS of two groups were 8.3(95%CI, 6.9–9.6) months and 8.8 (95%CI, 6.9–10.7) months, respectively. There was no statistical difference between the two groups in terms of OS or PFS. The ORR for the two groups was 48.2% (95%CI, 34.8–61.8) and 47.3% (95%CI, 39.1–5.6), respectively. However, due to the limited sample size, the difference was not statistically significant. On the other hand, the DCR tended to be higher in the Pembrolizumab group (86.5%; 95%CI, 79.7–91.4) compared to the modified PD‐1 inhibitors group (78.6%; 95%CI, 65.2–87.9), and this difference was statistically significant ( p = 0.006). In terms of safety, both groups exhibited favorable clinical safety profiles. The only two types of potentially immune‐related adverse events reported were pneumonitis and reactive cutaneous capillary endothelial proliferation (RCCEP).
Conclusions
The modified PD‐1 inhibitors showed comparable survival outcomes and manageable safety profiles in NSCLC compared to Pembrolizumab. Moreover, these inhibitors exhibited improved accessibility and economic outcomes compared to Pembrolizumab. While there were similarities in drug‐related and immunotherapy‐related adverse reactions between the modified PD‐1 inhibitors and Pembrolizumab, there were some slight differences. Further prospective and retrospective studies would be necessary to validate these findings beyond the scope of the CTONG1901 study.
... Other cancer-related management costs, including routine follow-up costs, best supportive care and terminal care costs, were obtained from published studies as with previous economic evaluations in China. 23,24 Sensitivity Analysis ...
Purpose
The five-year update data from the KEYNOTE-407 study have unveiled noteworthy improvements in survival outcomes achieved with pembrolizumab plus chemotherapy (Pembro+Chemo) compared to placebo plus chemotherapy (Placebo+Chemo) for patients with previously untreated metastatic squamous non-small cell lung cancer (NSCLC). Building upon this finding, our study sought to evaluate the cost-effectiveness of Pembro+Chemo, utilizing the latest available data, from the perspective of the Chinese health care system.
Patients and Methods
A Markov model was employed to compare the quality-adjusted life-year (QALY), life-year (LY), total cost, and incremental cost-effectiveness ratio (ICER) between Pembro+Chemo and Placebo+Chemo. The clinical and safety data were derived from the five-year update date of the KEYNOTE-407 study. Sensitivity analyses were conducted to assess the uncertainty of the model, and additional subgroup analyses were performed to explore specific subpopulations.
Results
For patients with previously untreated metastatic squamous NSCLC, the utilization of Pembro+Chemo resulted in a improvement of 0.61 quality-adjusted life years (QALYs) along with a cost reduction of $17,491.52 when compared to Placebo+Chemo. Notably, across various subgroups with different tumor proportion scores (TPS), Pembro+Chemo demonstrated enhanced QALYs and lower total costs.
Conclusion
From the perspective of the Chinese health care system, first-line Pembro+Chemo emerges as a dominant treatment option over Placebo+Chemo for the treatment of metastatic squamous NSCLC.
... Inhibitors of programmed cell death protein 1 (PD-1) and its associated ligand (PD-L1) as medicines of immunotherapy, the most promising treatment for cancers (Tang J, 2018;Cancer Research Institute, 2022), have been used for non-small-cell lung cancer (Brahmer et al., 2015;Jia et al., 2018;Gao et al., 2019), Hodgkin's lymphoma (Ansell et al., 2015;Jia et al., 2018;Gao et al., 2019), and others in recent years. However, some disadvantages of PD-1/PD-L1 inhibitors have emerged, such as marked differences in effective response rate among different people (Su et al., 2019;Daassi et al., 2020;Beaver and Pazdur, 2022) and the high cost of the inhibitors (Tarhini et al., 2019;Cheng et al., 2022). ...
Inhibitors of programmed cell death protein 1 and its associated ligand (PD-L1) are widely used in cancer treatment. However, medical costs and benefits of PD-1/PD-L1 inhibitors need attention owing to differences in response rates among individuals. This study explored global trends in the health economics field of PD-1/PD-L1 inhibitors to enhance their worldwide development. Bibliometric analysis of all documents currently indexed in Web of Science Core Collection from inception to 2022 was performed. Publication year, authors, countries, institutes, and journals were analyzed by Bibliometrix package (version 3.2.1) in R (version 4.1.3). CiteSpace (version 6.1.R6) and VOSviewer (version 1.6.18) were used to analyze burst words, co-authorship of institutes, co-cited journals, and co-cited references, while figures were mainly drawn by Ggplot2 package (version 3.3.5) in R (version 4.1.3) and SCImago Graphica Beta (version 1.0.23). A total of 2020 documents related to the health economics of PD-1/PD-L1 inhibitors were identified, and 1,204 documents met the selection criteria for inclusion in the study. A rapid increase in the number of publications since 2019 was observed, but this increase stopped in 2022, revealing research saturation in the field. Value in Health (166 publications, 13.79% of total documents) had the most publications, while New England Journal of Medicine (2,890 co-citations) was the most co-cited journal. The United States was the leading contributor in this field with 506 publications and the top two productive institutes globally. The main hot topics included the cost-effectiveness of treatment with PD-1 and/or PD-L1 inhibitors, and the comparison between the cost-effectiveness of PD-/PD-L1 inhibitors and other drugs. There were substantial differences between developed and developing countries in the health economics field of PD-1 and/or PD-L1 inhibitors. The cost-effectiveness analysis of combined treatment with PD-1/PD-L1 inhibitors and other drugs warrants further attention. Findings from this study may provide governments and pharmaceutical companies with a strong reference for future research.
This study examined the cost-effectiveness of first-line toripalimab plus chemotherapy (TC) for patients with advanced non-small cell lung cancer (NSCLC), excluding patients with nonsquamous NSCLC and EGFR/ALK mutations. It further analyzed the cost-effectiveness of this strategy in biomarker-based subgroups, all within the context of the Chinese healthcare system.
Eighteen Markov models with 21-day Markov cycle lengths and 30-year time horizons were constructed in this study. Clinical effectiveness data were derived from the CHOICE-01 trial. Health state utilities and costs data were obtained from various sources. The primary outputs were the calculation of incremental cost-effectiveness ratios (ICERs), which were then compared to a willingness-to-pay (WTP) threshold of $17,961 per quality-adjusted life-year (QALY). This comparison was used to determine the treatment that offered greater cost-effectiveness. To account for uncertainty in the model, sensitivity analyses were conducted.
For the overall patient population, the estimated ICER between first-line TC and placebo plus chemotherapy (PC) was $9445/QALY, significantly lower than the WTP threshold used in the model. In subgroups based on pathologic types, first-line TC had an ICER of $16,757/QALY for patients with nonsquamous NSCLC, slightly below the WTP threshold; first-line TC demonstrated dominance in patients with squamous NSCLC, indicating both better effectiveness and lower costs compared to first-line PC. In biomarkers-based subgroups, first-line TC was dominant over first-line PC in the subgroups with programmed cell death ligand 1 (PD-L1) expression ≥ 50% and SMARCA4 mutations. Moreover, first-line TC had ICERs lower than the WTP threshold in other subgroups, except for the subgroup with RB1 mutations. Sensitivity analysis confirmed the robustness of these findings.
From the perspective of the Chinese healthcare system, this study’s findings suggested that first-line TC represents a cost-effective strategy for patients with advanced NSCLC. However, the cost-effectiveness of first-line TC varied across different subgroups when considering predictive biomarkers.
