Franchi Matteo, Pellegrini Giacomo, Corrao Giovanni
Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy.
National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy.
Pharmaceuticals (Basel). 2022 Apr 18;15(4):489. doi: 10.3390/ph15040489.
No evidence is available on the head-to-head comparison of clinical outcomes of patients treated with immune checkpoint inhibitors (ICIs) for advanced non-small cell lung cancer (NSCLC) in a real-world setting. We aimed to compare the effectiveness and cost-effectiveness profile of nivolumab, pembrolizumab and atezolizumab. We used a population-based retrospective cohort study based on the healthcare utilization databases of the Lombardy Region, Italy. The study cohort included all patients with a diagnosis of lung cancer, who started a second-line treatment for advanced NSCLC with nivolumab, pembrolizumab or atezolizumab from 2015 to 30 June 2020. Overall survival and average cumulative healthcare costs were measured from the start of second-line treatment until 31 December 2020. The study cohort included 1607 patients who started a second-line treatment with ICIs, of which there were 1193 with nivolumab, 138 with pembrolizumab and 276 with atezolizumab. No differences were observed between treatment arms in terms of sex, age or comorbidities. Median OS was very similar between groups, being 8.9, 9.4 and 8.7 months, respectively, in patients treated with nivolumab, pembrolizumab and atezolizumab ( = 0.898). The adjusted hazard ratio of death of patients treated with pembrolizumab and atezolizumab, as compared to nivolumab, were 1.01 (95% CI: 0.81 to 1.25) and 1.03 (0.88 to 1.21), respectively. Healthcare cumulative costs measured in the first two years of follow-up were EUR 43,764, 46,233 and 34,116, on average, associated with nivolumab, pembrolizumab and atezolizumab, respectively. In our real-world study, atezolizumab was the ICI associated with the most favorable cost-effectiveness profile.
在真实世界中，尚无关于接受免疫检查点抑制剂（ICI）治疗的晚期非小细胞肺癌（NSCLC）患者临床结局的头对头比较的证据。我们旨在比较纳武利尤单抗、帕博利珠单抗和阿替利珠单抗的有效性和成本效益。我们基于意大利伦巴第地区的医疗保健利用数据库进行了一项基于人群的回顾性队列研究。研究队列包括所有被诊断为肺癌的患者，他们在2015年至2020年6月30日期间开始使用纳武利尤单抗、帕博利珠单抗或阿替利珠单抗进行晚期NSCLC的二线治疗。从二线治疗开始至2020年12月31日测量总生存期和平均累积医疗保健成本。研究队列包括1607例开始使用ICI进行二线治疗的患者，其中1193例使用纳武利尤单抗，138例使用帕博利珠单抗，276例使用阿替利珠单抗。在治疗组之间，在性别、年龄或合并症方面未观察到差异。各组的中位总生存期非常相似，接受纳武利尤单抗、帕博利珠单抗和阿替利珠单抗治疗的患者分别为8.9个月、9.4个月和8.7个月（ = 0.898）。与纳武利尤单抗相比，接受帕博利珠单抗和阿替利珠单抗治疗的患者的调整后死亡风险比分别为1.01（95%CI：0.81至1.25）和1.03（0.88至1.21）。在随访的前两年中，平均而言，与纳武利尤单抗、帕博利珠单抗和阿替利珠单抗相关的医疗保健累积成本分别为43,764欧元、46,233欧元和34,116欧元。在我们的真实世界研究中，阿替利珠单抗是成本效益最有利的ICI。
