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Economic Evaluations of Immune Checkpoint Inhibitors for Patients with Non-Small Cell Lung Cancer: A Systematic Review

Authors Li N, Zheng H, Zheng B, Chen C, Cai H, Liu M

Received 1 February 2020

Accepted for publication 9 May 2020

Published 12 June 2020 Volume 2020:12 Pages 4503—4518

DOI https://doi.org/10.2147/CMAR.S248020

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Antonella D'Anneo


Na Li,1,2,* Huanrui Zheng,1,2,* Bin Zheng,1,2 Chaoxin Chen,1,2 Hongfu Cai,1,2 Maobai Liu1,2

1Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, People’s Republic of China; 2School of Pharmacy, Fujian Medical University, Fuzhou, Fujian Province, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Maobai Liu
Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, People’s Republic of China
Email liumaobai@163.com

Objective: This review aimed to assess the quality of available evidence on the economic evaluations of immune checkpoint inhibitors in patients with non-small cell lung cancer (NSCLC) and provide evidence to improve the efficiency of healthcare resources.
Materials and Methods: Literature search was performed using some electronic databases (PubMed, Embase and Cochrane Central Register of Controlled Trials). Final search was performed in December 2019. Study characteristics and results were recorded and compared. The quality of the studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklists. We did not elaborate the restrictions on the target population. We included patients with squamous or non-squamous NSCLC and metastatic or advanced cancer.
Results: Of 98 papers considered, 21 were chosen for this review. Most of them are cost-effectiveness analysis. Comparative regimens consisted of either immune checkpoint inhibitor monotherapy, immune checkpoint inhibitor plus chemotherapy, or chemotherapy alone. Fourteen, four, and three studies were about pembrolizumab, nivolumab, and atezolizumab, respectively. The methods mostly used in these studies were modeling and sensitivity analysis. All studies used quality-adjusted life year (QALY) and life years (LY) as outcomes. Most studies were conducted in high-income countries. Based on the willingness to pay threshold, atezolizumab, and pembrolizumab were found to be cost-effective in one and 10 studies, respectively. None of the studies concluded that nivolumab was cost-effective. For quality assessment, all studies fulfilled more than 50% of the CHEERS checklist.
Conclusion: The included studies indicated that pembrolizumab regimens are cost-effective as first-line treatment for patients with NSCLC in developed countries. Nivolumab and atezolizumab are likely to be cost-effective as second-line treatment but not as first-line treatment.

Keywords: non-small cell lung cancer, economic analyses, immune checkpoint inhibitors, systematic review, PD-L1 positive

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