Zaim Remziye, Redekop W Ken, Uyl-de Groot Carin A
Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
Front Health Serv. 2023 Mar 13;3:1034256. doi: 10.3389/frhs.2023.1034256. eCollection 2023.
To assess the methodological quality of cost-effectiveness analyses (CEA) of nivolumab in combination with ipilimumab, we conducted a systematic literature review in the first-line treatment of patients with recurrent or metastatic non-small cell lung cancer (NSCLC), whose tumors express programmed death ligand-1, with no epidermal growth factor receptor or anaplastic lymphoma kinase genomic tumor aberrations. PubMed, Embase, and the Cost-Effectiveness Analysis Registry were searched, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The methodological quality of the included studies was assessed by the Philips checklist and the Consensus Health Economic Criteria (CHEC) checklist. 171 records were identified. Seven studies met the inclusion criteria. Cost-effectiveness analyses differed substantially due to the applied modeling methods, sources of costs, health state utilities, and key assumptions. Quality assessment of the included studies highlighted shortcomings in data identification, uncertainty assessment, and methods transparency. Our systematic review and methodology assessment revealed that the methods of estimation of long-term outcomes, quantification of health state utility values, estimation of drug costs, the accuracy of data sources, and their credibility have important implications on the cost-effectiveness outcomes. None of the included studies fulfilled all of the criteria reported in the Philips and the CHEC checklists. To compound the economic consequences presented in these limited number of CEAs, ipilimumab's drug action as a combination therapy poses significant uncertainty. We encourage further research to address the economic consequences of these combination agents in future CEAs and the clinical uncertainties of ipilimumab for NSCLC in future trials.
为评估纳武单抗联合伊匹木单抗成本效益分析（CEA）的方法学质量，我们针对肿瘤表达程序性死亡配体-1、无表皮生长因子受体或间变性淋巴瘤激酶基因组肿瘤畸变的复发或转移性非小细胞肺癌（NSCLC）患者一线治疗进行了系统文献综述。按照系统评价和Meta分析的首选报告项目指南，检索了PubMed、Embase和成本效益分析注册库。采用飞利浦清单和共识卫生经济标准（CHEC）清单评估纳入研究的方法学质量。共识别出171条记录。7项研究符合纳入标准。由于所应用的建模方法、成本来源、健康状态效用和关键假设不同，成本效益分析差异很大。纳入研究的质量评估突出了数据识别、不确定性评估和方法透明度方面的不足。我们的系统综述和方法学评估表明，长期结局的估计方法、健康状态效用值的量化、药物成本的估计、数据源的准确性及其可信度对成本效益结果具有重要影响。纳入的研究均未满足飞利浦清单和CHEC清单中报告的所有标准。为了加重这些数量有限的CEA中呈现的经济后果，伊匹木单抗作为联合治疗药物的作用带来了重大不确定性。我们鼓励进一步开展研究，以解决未来CEA中这些联合药物的经济后果以及未来试验中伊匹木单抗用于NSCLC的临床不确定性问题。
