Details regarding cost-effectiveness studies of non-small cell lung cancer

Reference, Country, YearComparisonMethodologybCostsQALYsICERWTPConclusionsCriticisms
Goeree et al., Canada, 2016 [28]Nivo vs. doc vs. erl for recurrent stage IIIB/IV SCCPSa + Markov; accounted for toxicity, administration, and end-of-life costsCAD 139,016 ($107,631) nivo, CAD 38,812 ($30,049) doc, CAD 39,920 ($30,906) erl1.23 nivo, 0.58 doc, 0.54 erlRelative to doc, nivo CAD 152,229 ($117,857)/QALY and relative to erl, 141,838 ($109,811)/QALYNo specific amount in CanadaCompared with doc or erl, nivo may or may not be CE depending on WTP threshold- Overall modeling horizon of 10 years, when low numbers of patients still alive, causing errors in survival extrapolation and thus costs- Difficulty in interpreting next-line therapies- Only grade ≥ 3 toxicities accounted for, as a one-time cost
Matter-Walstra et al., Switzerland, 2016 [29]PD-L1 testing + subsequent decision vs. nivo vs. doc for recurrent non-SCCMarkov; PD-L1 testing cutoffs ≥1% and ≥ 10%; accounted for end-of-life costs and reducing nivo dose and durationCHF 37,618 ($39,378) doc, CHF 66,208 ($69,306) nivo, CHF 47,410 ($49,628) nivo with dose reduction, CHF 55,394 ($57,992) with duration reduction0.53 doc, 0.69 nivoRelative to doc, nivo CHF 177,478 ($185,802)/QALY, reduced dose CHF 60,787 ($63,638)/QALY, reduced duration CHF 110,349 ($115,524)/QALYCHF 100,000 ($104,690) /QALYAlthough not at baseline, nivo is CE by dose reduction and increased PD-L1 threshold- Overall modeling horizon of complete lifetime, causing errors in survival extrapolation and thus costs- In addition to lack of a discount rate, did not account for most toxicities, administration, or death costs- Median PFS favored doc, but 1-year PFS favored nivo; difficult to account for in model
Aguiar et al., USA, 2017 [30]Nivo, pembro, or atezo ± prior PD-L1 testing vs. doc for recurrent SCC/non-SCCDecision-analytic model; PD-L1 testing cutoffs ≥1%/≥5%/≥10% for nivo and ≥ 1%/50% for pembro; accounted for administration, monitoring, end-of-life costs$140,453 nivo for SCC and $100,791 nivo for non-SCC (PD-L1 untested), $82,201 pembro (PD-L1 ≥ 1%), $122,155 atezo (PD-L1 untested); doc $39,516–$48,1820.82 nivo (SCC), 0.87 nivo (non-SCC), 0.92 pembro, 0.90 atezo, 0.54–0.59 docRelative to doc, nivo $155,605/QALY (SCC) and nivo $187,685/QALY (non-SCC), pembro $98,421/QALY, atezo $215,802/QALY$100,000/QALYAtezo not CE; pembro is CE; although not at baseline, nivo is CE by increased PD-L1 threshold- Toxicity types and one-time costs thereof not explained- Unclear whether patients treated until PD, along with details of next-line therapy (if present)- Analysis and reflections based on USA Medicare system, limiting broader applicability
Huang et al., USA, 2017 [31]Pembro vs. doc for recurrent non-SCCPS; PD-L1 testing cutoff ≥50%; accounted for toxicity, administration, end-of-life costs$136,921 doc, $297,443 pembro0.76 doc, 1.71 pembroRelative to doc, pembro $168,619/QALYPer capita GDP × 3Pembro CE at the particular WTP threshold, which is nonstandard and thus questionable- Overall modeling horizon of 20 years, when exceedingly low numbers of patients still alive, causing errors in survival extrapolation, which was done through retrospective population datasets- Survival found to most influence costs; thus, extrapolation may markedly influence overall costs- Only grade ≥ 3 toxicities accounted for, as a one-time cost
Huang et al., USA, 2017 [31]Pembro vs. several types of chemo for first-line SCC/non-SCCPS; PD-L1 testing cutoff ≥50%; accounted for toxicity, administration, end-of-life costs$260,223 chemo, $362,662 pembro1.55 chemo, 2.60 pembroRelative to chemo, pembro $97,621/QALYNo specific amount usedPembro is CE in this setting- Overall modeling horizon of 20 years, when exceedingly low numbers of patients still alive, causing errors in survival extrapolation (done through retrospective population datasets), which may impact costs secondarily- Heterogeneity in treating with variety of chemo- Only grade ≥ 3 toxicities accounted for, as a one-time cost

QALY quality-adjusted life year, ICER incremental cost-effectiveness ratio, WTP willingness to pay (threshold); nivo, nivolumab; doc, docetaxel; erl, erlotinib; SCC squamous cell carcinoma, PS partitioned survival, CAD Canadian dollar, CE cost-effective, PFS progression-free survival, OS overall survival, PD-L1 programmed cell death ligand-1, CHF Swiss francs

aData for partitioned survival model not shown owing to virtual similarity as Markov data

bAll studies consisted of three basic health states (progression-free (stable), progressive disease, and death); all studies performed sensitivity analyses in addition to the base case