Department of Pharmacy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China.
Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
PLoS One. 2020 Sep 2;15(9):e0238536. doi: 10.1371/journal.pone.0238536. eCollection 2020.
Immune checkpoint inhibitors (ICIs) for treatment of non-small cell lung cancer (NSCLC) have been rapidly evolving. ICIs are likely to be more effective but also lead to escalating healthcare costs.
The aim of this study was to evaluate the cost effectiveness of immune checkpoint inhibitors (ICIs) for treatment of non-small cell lung cancer (NSCLC).
We searched the PubMed, Web of Science, and Cochrane Library for studies comparing the cost effectiveness of ICIs for NSCLC. Potential studies identified were independently checked for eligibility by two authors, with disagreement resolved by a third reviewer. Quality of the included studies was evaluated using Consolidated Health Economic Evaluation Reporting Standards checklists.
A total of 22 economic studies were included. Overall reporting of the identified studies largely met CHEERS recommendations. In the first-line setting, for advanced or metastatic NSCLC patients with PD-L1 ≥ 50%, pembrolizumab appeared cost-effective compared with platinum-based chemotherapy in the US and Hong Kong (China), but not in the UK and China. The cost-effectiveness of pembrolizumab versus chemotherapy for first-line treatment of NSCLC in PD-L1 ≥ 1% patients remained obscure. Regardless of PD-L1 expression status, pembrolizumab in combination with chemotherapy could be a cost-effective first-line therapy in the US. On the contrary, addition of atezolizumab to the combination of bevacizumab and chemotherapy was not cost-effective for patients with metastatic non-squamous NSCLC from the US payer perspective. In the second-line setting compared with docetaxel, pembrolizumab was cost-effective; though nivolumab was not cost-effective in the base case, it could be by increased PD-L1 threshold. Results of the cost-effectiveness of atezolizumab second-line treatment remained inconsistent. In addition, the adoption of durvalumab consolidation therapy after chemoradiotherapy could be cost-effective versus no consolidation therapy for patients with stage III NSCLC.
Immunotherapy can be a cost-effective option for treatment of NSCLC in several scenarios. A discount of the agents or the use of PD-L1 expression as a biomarker improves the cost-effectiveness of immunotherapy.
免疫检查点抑制剂（ICI）在非小细胞肺癌（NSCLC）的治疗中发展迅速。ICI 可能更有效，但也会导致医疗保健成本的不断上升。
本研究旨在评估免疫检查点抑制剂（ICI）治疗非小细胞肺癌（NSCLC）的成本效果。
我们在 PubMed、Web of Science 和 Cochrane Library 中搜索了比较 NSCLC 中 ICI 的成本效果的研究。由两名作者独立检查潜在研究的资格，并由第三位审稿人解决分歧。使用统一的健康经济评估报告标准清单评估纳入研究的质量。
共纳入 22 项经济研究。总体而言，所确定研究的报告在很大程度上符合 CHEERS 建议。在一线治疗中，对于 PD-L1≥50%的晚期或转移性 NSCLC 患者，pembrolizumab 在美国和中国香港（中国）被认为比基于铂的化疗更具成本效益，但在英国和中国并非如此。对于 PD-L1≥1%的 NSCLC 患者，pembrolizumab 与化疗相比作为一线治疗的成本效益仍然不清楚。无论 PD-L1 表达状态如何，pembrolizumab 联合化疗在美国可能是一种具有成本效益的一线治疗方法。相反，从美国支付者的角度来看，atezolizumab 联合贝伐珠单抗和化疗对转移性非鳞状 NSCLC 患者的疗效并不具有成本效益。在二线治疗中，与多西他赛相比，pembrolizumab 具有成本效益；尽管 nivolumab 在基础情况下不具有成本效益，但可以通过增加 PD-L1 阈值来实现。atezolizumab 二线治疗的成本效益结果仍然不一致。此外，对于 III 期 NSCLC 患者，在放化疗后接受 durvalumab 巩固治疗可能比不进行巩固治疗更具成本效益。
免疫疗法在几种情况下可能是治疗 NSCLC 的一种具有成本效益的选择。对药物进行折扣或使用 PD-L1 表达作为生物标志物可以提高免疫疗法的成本效益。
