A systematic review of the cost and cost-effectiveness studies of immune checkpoint inhibitors. Issue 1 (23rd November 2018)

• Record Type: Journal Article
• Authors: Verma, Vivek; Sprave, Tanja; Haque, Waqar; Simone, Charles B.; Chang, Joe Y.; Welsh, James W.; Thomas, Charles R.
• Is Part Of: Journal for immunotherapy of cancer. Volume 6:Issue 1(2018)
• Publication Date: 2018-11-23
• Subjects: Cost-effectiveness -- Value -- Immunotherapy -- Immune checkpoint inhibitor -- Public policy -- Public health -- Health policy; Cancer -- Immunotherapy -- Periodicals; Cancer -- Immunological aspects -- Periodicals; Tumors -- Immunological aspects -- Periodicals; Immunotherapy -- Periodicals; 616.99406105
• DOI: 10.1186/s40425-018-0442-7
• Languages: English
• ISSNs: 2051-1426

Abstract

Abstract : Background: Escalating healthcare costs are necessitating the practice of value-based oncology. It is crucial to critically evaluate the economic impact of influential but expensive therapies such as immune checkpoint inhibitors (ICIs). To date, no systematic assessment of the cost-effectiveness (CE) of ICIs has been performed. Methods: PRISMA-guided systematic searches of the PubMed database were conducted. Studies of head/neck ( n = 3), lung ( n = 5), genitourinary ( n = 4), and melanoma ( n = 8) malignancies treated with ICIs were evaluated. The reference willingness-to-pay (WTP) threshold was $100, 000/QALY. Results: Nivolumab was not cost-effective over chemotherapy for recurrent/metastatic head/neck cancers (HNCs). For non-small cell lung cancer (NSCLC), nivolumab was not cost-effective for a general cohort, but increased PD-L1 cutoffs resulted in CE. Pembrolizumab was cost-effective for both previously treated and newly-diagnosed metastatic NSCLC. For genitourinary cancers (GUCs, renal cell and bladder cancers), nivolumab and pembrolizumab were not cost-effective options. Regarding metastatic/unresected melanoma, ipilimumab monotherapy is less cost-effective than nivolumab, nivolumab/ipilimumab, and pembrolizumab. The addition of ipilimumab to nivolumab monotherapy was not adequately cost-effective. Pembrolizumab or nivolumab monotherapy offered comparable CE profiles. Conclusions: With limited data and from the reference WTP, nivolumab was not cost-effective for HNCs. Pembrolizumab was cost-effective for NSCLC; although not the case for nivolumab, applying PD-L1 cutoffs resulted in adequate CE. Most data for nivolumab and pembrolizumab in GUCs did not point towards adequate CE. Contrary to ipilimumab, either nivolumab or pembrolizumab is cost-effective for melanoma. Despite these conclusions, it cannot be overstated that careful patient selection is critical for CE. Future publication of CE investigations and clinical trials (along with longer follow-up of existing data) could substantially alter conclusions from this analysis.