Li Na, Zheng Huanrui, Zheng Bin, Chen Chaoxin, Cai Hongfu, Liu Maobai
Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, People's Republic of China.
School of Pharmacy, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China.
Cancer Manag Res. 2020 Jun 12;12:4503-4518. doi: 10.2147/CMAR.S248020. eCollection 2020.
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.
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.
Of 98 papers considered, 21 were chosen for this review. Most of them are cost-effectiveness 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.
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.
本综述旨在评估非小细胞肺癌（NSCLC）患者免疫检查点抑制剂经济评估的现有证据质量，并为提高医疗资源利用效率提供依据。
使用一些电子数据库（PubMed、Embase和Cochrane对照试验中央注册库）进行文献检索。最终检索于2019年12月进行。记录并比较研究特征和结果。使用综合卫生经济评估报告标准（CHEERS）清单评估研究质量。我们未详细说明对目标人群的限制。我们纳入了鳞状或非鳞状NSCLC以及转移性或晚期癌症患者。
在98篇被考虑的论文中，21篇被选入本综述。其中大多数是成本效益分析。比较方案包括免疫检查点抑制剂单药治疗、免疫检查点抑制剂加化疗或单纯化疗。分别有14项、4项和3项研究涉及帕博利珠单抗、纳武利尤单抗和阿替利珠单抗。这些研究中最常用的方法是建模和敏感性分析。所有研究均使用质量调整生命年（QALY）和生命年（LY）作为结局指标。大多数研究在高收入国家进行。根据支付意愿阈值，分别有1项和10项研究发现阿替利珠单抗和帕博利珠单抗具有成本效益。没有研究得出纳武利尤单抗具有成本效益的结论。在质量评估方面，所有研究均满足CHEERS清单超过50%的要求。
纳入的研究表明，在发达国家，帕博利珠单抗方案作为NSCLC患者的一线治疗具有成本效益。纳武利尤单抗和阿替利珠单抗作为二线治疗可能具有成本效益，但作为一线治疗则不然。
