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

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    Author
    Verma, V.
    Sprave, T.
    Haque, W.
    Date
    2018
    Journal
    Journal for ImmunoTherapy of Cancer
    Publisher
    BioMed Central Ltd.
    Type
    Review
    
    Metadata
    Show full item record
    See at
    https://dx.doi.org/10.1186/s40425-018-0442-7
    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. Copyright 2018 The Author(s).
    Keyword
    Cost-effectiveness
    Health policy
    Immune checkpoint inhibitor
    Immunotherapy
    Public health
    Public policy
    Value
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85057075708&doi=10.1186%2fs40425-018-0442-7&partnerID=40&md5=e9d58876176b126f731b0bcc696af065; http://hdl.handle.net/10713/9205
    ae974a485f413a2113503eed53cd6c53
    10.1186/s40425-018-0442-7
    Scopus Count
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    UMB Open Access Articles 2018

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