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J Immunother Cancer. 2018 Nov 23;6(1):128. doi: 10.1186/s40425-018-0442-7.

A systematic review of the cost and cost-effectiveness studies of immune checkpoint inhibitors.

Author information

1
Department of Radiation Oncology, Allegheny General Hospital, 320 East North Ave, Pittsburgh, PA, 15212, USA. vivek333@gmail.com.
2
Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.
3
Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA.
4
Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA.
5
Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
6
Department of Radiation Oncology, Oregon Health & Science University, Portland, OR, USA.

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.

KEYWORDS:

Cost-effectiveness; Health policy; Immune checkpoint inhibitor; Immunotherapy; Public health; Public policy; Value

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