Business School Postgraduate Program (PPAD), Pontifícia Universidade Católica do Paraná (PUCPR), Imaculada Conceição, 1155, 80215-901, Curitiba, PR, Brazil.
School of Management, Universidade Federal do Paraná (UFPR), 632 Lothário Meissner Ave, Jardim Botânico, 80210-170, Curitiba, PR, Brazil.
Crit Rev Oncol Hematol. 2018 Sep;129:133-145. doi: 10.1016/j.critrevonc.2018.07.002. Epub 2018 Jul 17.
A better understanding of the modulation of the immune system has resulted in the development of new classes of antitumor agents such as nivolumab and pembrolizumab. Despite the proven effectiveness and tolerability of these new drugs for specific types of cancer, the high cost of treatment has affected their accessibility.
The aim of this study is to conduct a meta-narrative review of studies that have addressed the concerns that have been voiced regarding the cost of and access to nivolumab and pembrolizumab in oncology health care. This meta-narrative review attempts to answer the following questions: (1) which papers have considered this broad topic area?; (2) what are the main empirical/theoretical findings?; and (3) what insights can be drawn by combining and comparing findings from different papers?
A meta-narrative review has been conducted in 5 research databases (Web of Science, Science Direct, Scopus, Embase and Pubmed) without time limitations up to January of 2017 to address concerns related to the cost of and access to nivolumab and pembrolizumab in oncology health care. From each research base, articles were selected that had a key word related to the theme of pharmacoeconomics and nivolumab or pembrolizumab in any field of scientific work. The research questions were analyzed through the application of a meta-narrative review approach and the use of a convergence-coding matrix to summarize similarities and differences directly related to the research topic between the different papers.
The first contribution of this meta-narrative review is that it summarizes economic-based works on the use of nivolumab and pembrolizumab, particularly for three therapeutic indications: melanoma, NSCLC and RCC. In general, despite the clinical benefit of nivolumab and pembrolizumab being well accepted and proven by scientific works, the published studies show that there are contradictory results with regard to the cost-effectiveness of these anti-PD-1s. The regulatory, economic and epidemiological variations mean that healthcare costs for cancer patients vary greatly from country to country and according to the type of tumor. The second contribution has to do with the recommendations for the development of high quality process for pharmacoeconomic analyses, especially in the new field of immuno-oncology. Finally, the third contribution is with regard to recommendations for the sustainable use of immunotherapies.
Given the revolution in cancer therapy in recent years, the efficient allocation of existing resources is essential for healthcare systems to meet the evolving needs of populations and remain sustainable in the long term. The application of high quality information that stems from scientific evidence and economic modeling can help considerably to make the healthcare system sustainable over time mainly due to a higher number of therapeutic indications or more countries giving regulatory approval for the use of new and expensive cancer drugs.
对免疫系统的调节有了更好的理解，导致了新的抗肿瘤药物类别的发展，如 nivolumab 和 pembrolizumab。尽管这些新药物对特定类型的癌症具有已证实的有效性和可耐受性，但治疗费用高昂影响了其可及性。
本研究旨在对已解决有关肿瘤学保健中 nivolumab 和 pembrolizumab 的成本和可及性问题的研究进行元叙事综述。本元叙事综述试图回答以下问题：（1）哪些论文考虑了这个广泛的主题领域？; （2）主要的经验/理论发现是什么？; （3）通过合并和比较不同论文的结果，可以得出哪些见解？
在没有时间限制的情况下，截至 2017 年 1 月，在 5 个研究数据库（Web of Science、Science Direct、Scopus、Embase 和 Pubmed）中进行了元叙事综述，以解决与肿瘤学保健中 nivolumab 和 pembrolizumab 的成本和可及性相关的问题。从每个研究基地中，选择了在任何科学工作领域都与药物经济学和 nivolumab 或 pembrolizumab 主题相关的关键词的文章。通过应用元叙事综述方法和使用收敛编码矩阵来分析研究问题，直接总结不同论文中与研究主题相关的相似和不同之处。
本元叙事综述的第一个贡献是它总结了基于经济学的关于 nivolumab 和 pembrolizumab 使用的工作，特别是针对三种治疗适应症：黑色素瘤、非小细胞肺癌和肾细胞癌。一般来说，尽管 nivolumab 和 pembrolizumab 的临床获益已被科学研究广泛接受和证实，但已发表的研究表明，这些抗 PD-1s 的成本效益存在相互矛盾的结果。监管、经济和流行病学的变化意味着癌症患者的医疗保健费用在各国之间以及根据肿瘤类型而有很大差异。第二个贡献与制定高质量药物经济学分析流程的建议有关，特别是在免疫肿瘤学的新领域。最后，第三个贡献是关于免疫疗法可持续使用的建议。
鉴于近年来癌症治疗的革命，为了满足人口不断发展的需求并保持长期可持续性，医疗保健系统必须有效地分配现有资源。应用源于科学证据和经济建模的高质量信息可以在很大程度上帮助医疗保健系统随着时间的推移保持可持续性，主要是因为有更多的治疗适应症或更多的国家批准使用新的和昂贵的癌症药物。
