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dc.contributor.authorVerma, V.*
dc.contributor.authorSprave, T.*
dc.contributor.authorHaque, W.*
dc.date.accessioned2019-05-17T13:21:17Z
dc.date.available2019-05-17T13:21:17Z
dc.date.issued2018
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85057075708&doi=10.1186%2fs40425-018-0442-7&partnerID=40&md5=e9d58876176b126f731b0bcc696af065
dc.identifier.urihttp://hdl.handle.net/10713/9205
dc.description.abstractBackground: 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).en_US
dc.description.urihttps://dx.doi.org/10.1186/s40425-018-0442-7en_US
dc.language.isoen_USen_US
dc.publisherBioMed Central Ltd.en_US
dc.relation.ispartofJournal for ImmunoTherapy of Cancer
dc.subjectCost-effectivenessen_US
dc.subjectHealth policyen_US
dc.subjectImmune checkpoint inhibitoren_US
dc.subjectImmunotherapyen_US
dc.subjectPublic healthen_US
dc.subjectPublic policyen_US
dc.subjectValueen_US
dc.titleA systematic review of the cost and cost-effectiveness studies of immune checkpoint inhibitorsen_US
dc.typeReviewen_US
dc.identifier.doi10.1186/s40425-018-0442-7
dc.identifier.pmid30470252


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