Tian Wentao, Niu Lishui, Shi Yin, Li Shuishi, Zhou Rongrong
Department of Oncology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, China.
Department of Pharmacy, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan 41008, China.
Ther Adv Med Oncol. 2024 May 30;16:17588359241255613. doi: 10.1177/17588359241255613. eCollection 2024.
The combination of immune checkpoint inhibitors (ICIs) and chemotherapy is a promising first-line therapy for patients with advanced non-squamous non-small cell lung cancer (NSCLC). The cost-effectiveness of combinations with different ICIs is yet to be compared.
We utilized Bayesian network meta-analyses for the comparisons of overall survival, progression-free survival, and incidence of adverse events of the included treatments in the total population and subgroups with different programmed death-ligand 1 tumor proportional scores (TPS). The cost-effectiveness of the treatments from the perspectives of the US and Chinese healthcare systems was assessed using Markov models.
Three combinations, including pembrolizumab + chemotherapy (PembroC), nivolumab + ipilimumab + chemotherapy (NivoIpiC), and atezolizumab + chemotherapy (AteC), were included in our study. In terms of efficacy, PembroC was most likely to be ranked first for extending progression-free survival (PFS) (93.16%) and overall survival (OS) (90.73%). Nevertheless, from the US perspective, NivoIpiC and PembroC showed incremental cost-effectiveness ratios (ICERs) of $68,963.1/quality-adjusted life-years (QALY) and $179,355.6/QALY, respectively, compared with AteC. The one-way sensitivity analysis revealed that the results were primarily sensitive to the hazard ratios for OS or the cost of immunotherapy agents. At a willingness-to-pay (WTP) threshold of $150,000/QALY, NivoIpiC had the highest probability of being cost-effective (63%). As for the Chinese perspective, NivoIpiC and PembroC had ICERs of $145,983.4/QALY and $195,863.3/QALY AteC, respectively. The results were primarily sensitive to the HRs for OS. At a WTP threshold of $38,017/QALY, AteC had the highest probability of cost-effectiveness (94%).
Although PembroC has the optimal efficacy, NivoIpiC and AteC were the most favorable treatments in terms of cost-effectiveness for patients with advanced non-squamous NSCLC from the US and Chinese perspectives, respectively.
免疫检查点抑制剂（ICI）与化疗联合使用是晚期非鳞状非小细胞肺癌（NSCLC）患者一种很有前景的一线治疗方案。不同ICI联合方案的成本效益尚待比较。
我们利用贝叶斯网络荟萃分析，比较了总体人群以及不同程序性死亡配体1肿瘤比例评分（TPS）亚组中纳入治疗的总生存期、无进展生存期和不良事件发生率。使用马尔可夫模型从美国和中国医疗体系的角度评估了这些治疗方案的成本效益。
我们的研究纳入了三种联合方案，包括帕博利珠单抗联合化疗（PembroC）、纳武利尤单抗联合伊匹木单抗联合化疗（NivoIpiC）和阿替利珠单抗联合化疗（AteC）。在疗效方面，PembroC在延长无进展生存期（PFS）（93.16%）和总生存期（OS）（90.73%）方面最有可能排名第一。然而，从美国的角度来看，与AteC相比，NivoIpiC和PembroC的增量成本效益比（ICER）分别为68,963.1美元/质量调整生命年（QALY）和179,355.6美元/QALY。单向敏感性分析表明，结果主要对OS的风险比或免疫治疗药物的成本敏感。在支付意愿（WTP）阈值为150,000美元/QALY时，NivoIpiC具有成本效益的概率最高（63%）。从中国的角度来看，NivoIpiC和PembroC与AteC相比的ICER分别为145,983.4美元/QALY和195,863.3美元/QALY。结果主要对OS的风险比敏感。在WTP阈值为38,017美元/QALY时，AteC具有成本效益的概率最高（94%）。
尽管PembroC具有最佳疗效，但从美国和中国的角度来看，NivoIpiC和AteC分别是晚期非鳞状NSCLC患者在成本效益方面最有利的治疗方案。
