Cost-effectiveness analyses of targeted therapy and immunotherapy for advanced non-small cell lung cancer in the United States: a systematic review

ABSTRACT

Introduction: Mutation-targeting and immuno-oncology drugs are revolutionizing the treatment of advanced non-small cell lung cancer (NSCLC). Cost-effectiveness analyses (CEA) of these drugs have been conducted using various analytical methods and cost-effectiveness thresholds. This systematic review provides a comprehensive summary of the available evidence.

Area covered: PubMed, Embase, and Cochrane Library were used to select for CEA of targeted therapies for NSCLC in the United States published between 2008 and 2020. Among the 28 included studies, a majority were published from 2017 to 2020 (n = 18) and more than half targeted non-squamous NSCLC (n = 15). The most frequently evaluated therapy was pembrolizumab (n = 11), followed by bevacizumab (n = 8) and erlotinib (n = 4). After 2009, all included studies applied $100,000 or more thresholds. Thresholds of studies supported by industry (median = $150,000) were more distributed than those of studies supported by nonprofits (median = $100,000).

Expert commentary: Medications of interest have changed and are individualized to particular mutations. The cost-effectiveness thresholds varied among sponsors but generally trended to increase over time. This review provides an overview of the available cost-effectiveness findings for stakeholders and contributes to evidence-based practice.

KEYWORDS:

• Cost-effectiveness
• cost-effectiveness threshold
• immunotherapy
• non-small cell lung cancer
• systematic review
• targeted therapy

Article highlights

• The U.S. Food and Drug Administration has recently approved several mutation-targeting and immuno-oncology drugs for the treatment of advanced non-small cell lung cancer (NSCLC). Cost-effectiveness analyses (CEA) of these drugs have been conducted using various analytical methods and cost-effectiveness thresholds. This systematic review provides a comprehensive summary of the available evidence for decision-makers.

• Disease management of NSCLC has shifted towards more personalized approach with targeted therapies. A wide range of values for the cost-effectiveness threshold was used in industry, nonprofit and non-reported sponsored CEA, and have generally increased over time. With varying thresholds used for the same therapy, it may be difficult to come to a conclusion on whether a therapy is cost-effective.

• The summarized findings by interventions in this review will provide useful information about the available evidence and gaps in research for the cost-effectiveness of advanced NSCLC treatments for researchers, payers, and clinicians. Additionally, the overview of analytical approaches will help researchers identify the common analytic practices for CEA.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Abbreviations

NR: not reported; NA: not applied; DSA: deterministic sensitivity analysis; LYG: life years gained; PSA: probabilistic sensitivity analysis; QALY: quality-adjusted life years.

Additional information

Funding

This paper was not funded.