Cost-effectiveness of immune checkpoint inhibitors for non-small cell lung cancer in a third level hospital.

Abstract

Objectives: To evaluate the effectiveness and cost-effectiveness of immune checkpoint inhibitors in patients with non-small cell lung cancer (NSCLC) in real-world clinical practice.

Methods: A retrospective, single-center observational study including NSCLC patients treated with atezolizumab, durvalumab, nivolumab, and pembrolizumab between 2015 and 2023. Demographic, clinical, and treatment data, as well as adverse events, were recorded. Statistical analysis was performed using the R Core Team (2024) software.

Results: In stage IV, pembrolizumab demonstrated the longest median overall survival (OS) at 15.49 months, compared to nivolumab (10.26 months) and atezolizumab (9.24 months). In stage III, pembrolizumab reached an OS median of 34.64 months, nivolumab 17.03 months, and atezolizumab 10.62 months. Durvalumab reached an OS median of 30.18 months. In stage IV, the Incremental Cost-Effectiveness Ratio (ICER) of pembrolizumab versus atezolizumab was €517.92 per month of life gained, and the ICER of pembrolizumab versus nivolumab was €512.66 per month of life gained. In stage III with palliative intent, the ICER of pembrolizumab versus atezolizumab was €135.76 per month of life gained, and the ICER of pembrolizumab versus nivolumab was €152.26 per month of life gained.

Conclusions: Although real-world survival outcomes are lower than those reported in pivotal clinical trials, immunotherapy is established as an efficient strategy for the National Health System. All analyzed drugs were cost-effective in the hospital setting studied, falling below the efficiency thresholds proposed by the WHO for Spain (<€65,180/year). The sustainability of these high-budget-impact treatments depends on precise patient selection based on biomarkers and the implementation of dosage optimization strategies. There is a need for local economic evaluations to guide clinical and management decision-making.