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

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.

• Authors: Vivek Verma, Tanja Sprave, Waqar Haque, Charles B Simone 2nd, Joe Y Chang, James W Welsh, Charles R Thomas Jr
• Journal: Journal for immunotherapy of cancer (J Immunother Cancer) Vol. 6 Issue 1 Pg. 128 (11 23 2018) ISSN: 2051-1426 [Electronic] England
• PMID: 30470252 (Publication Type: Journal Article, Review, Systematic Review)

Chemical References

• Antibodies, Monoclonal
• Antineoplastic Agents

Topics

• Antibodies, Monoclonal (economics, therapeutic use)
• Antineoplastic Agents (economics, therapeutic use)
• Cost-Benefit Analysis
• Humans
• Immunotherapy (methods)