Pooled survival and cost-effectiveness analysis of immune checkpoint inhibitors-based for metastatic non-small-cell lung cancer with PD-L1 lower than 1.
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引用次数: 0
Abstract
Objective: This study aims to assess whether immune checkpoint inhibitors (ICIs)-based treatments offer significant survival benefits and economic viability for patients presenting with PD-L1 lower than 1%.
Methods: This exploratory analysis was based on individual patient data from randomized controlled trials (CheckMate-227, CheckMate-9LA, KEYNOTE-189, and KEYNOTE-407). Survival outcomes evaluated for this study were overall survival (OS) and progression-free survival (PFS). Economic evaluations estimated total lifetime costs, incremental cost-effectiveness ratios (ICERs), and incremental net-health benefit (INHB) using the Markov model. The willingness-to-pay (WTP) thresholds were $150,000/quality-adjusted life-year (QALY) for the USA and $36,942/QALY for China.
Results: Among patients receiving immunotherapy-based treatments (N = 754) relative to those treated with chemotherapy-alone (N = 502), survival outcomes were significantly improved (median OS: 17.0 vs. 12.0 months; hazard ratio [HR]: 0.69; 95% confidence interval [CI]: 0.61-0.78; median PFS: 6.5 vs. 5.5 months; HR: 0.68; 95% CI: 0.60-0.77). The cost-effectiveness analysis found that the ICERs with INHBs for immunotherapy-based versus chemotherapy-alone were $273,440.73/QALY with -1.00 QALYs in the USA and $32,783.93/QALY with 0.89 QALYs in China. Crucially, among ICI-based regimens, nivolumab plus ipilimumab-based (INHB: 0.09 QALYs) and pembrolizumab plus chemotherapy (INHB: 0.17 QALYs) were the most cost-effective options in the USA and China, respectively.
Conclusions: First-line immunotherapies-based therapy was cost-effective in metastatic NSCLC with PD-1 lower than 1% in China but not in the USA. Nivolumab plus ipilimumab-based was identified as the most favorable first-line immunotherapy in the USA, while pembrolizumab plus chemotherapy was preferred in China.
期刊介绍：
Health Economics Review is an international high-quality journal covering all fields of Health Economics. A broad range of theoretical contributions, empirical studies and analyses of health policy with a health economic focus will be considered for publication. Its scope includes macro- and microeconomics of health care financing, health insurance and reimbursement as well as health economic evaluation, health services research and health policy analysis. Further research topics are the individual and institutional aspects of health care management and the growing importance of health care in developing countries.
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