A Cost-Effectiveness Analysis of Nivolumab versus Docetaxel for Advanced Nonsquamous NSCLC Including PD-L1 Testing

Matter-Walstra, Klazien; Schwenkglenks, Matthias; Aebi, Stefan; Dedes, Konstantin J.; Diebold, Joachim; Pietrini, Mario; Klingbiel, Dirk; Moos, Roger von; Gautschi, Oliver

doi:10.1016/j.jtho.2016.05.032

Cited by 81 publications

(70 citation statements)

References 40 publications

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“…PD‐L1, as a pembrolizumab's molecular target, is widely expressed at tumor cells surface which is often tested by IHC assay. In comparison with other molecular diagnostic tests for nonsquamous NSCLC, PD‐L1 expression test was less expensive and more available . Based on the NCCN guideline for NSCLC (2019, V2), the degree of recommendation of PD‐L1 detection is raised from 2A to level 1.…”

Section: Discussionmentioning

confidence: 99%

“…In comparison with other molecular diagnostic tests for nonsquamous NSCLC, PD-L1 expression test was less expensive and more available. 38 Based on the NCCN guideline for NSCLC (2019, V2), the degree of recommendation of PD-L1 detection is raised from 2A to level 1. The FDA has recently approved pembrolizumab monotherapy as the first-line treatment for PD-L1-positive locally advanced/metastatic NSCLC, with PD-L1 expression ≥1%, meanwhile without EGFR or ALK genomic aberrations based on KEYNOTE-042 in April 2019.…”

Section: Discussionmentioning

confidence: 99%

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Cost‐effectiveness analysis of pembrolizumab plus chemotherapy with PD‐L1 test for the first‐line treatment of NSCLC

et al. 2020

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Background Pembrolizumab (Pembro) in combination with chemotherapy has been approved for the treatment of pretreated advanced NSCLC in the United States and China for its significant efficacy. However, the cost‐effectiveness is unknown considering Pembro's high price. The impact of programmed death ligand 1 (PD‐L1) test on the cost‐effectiveness is also unknown. The current study assessed the cost‐effectiveness of combination therapy for nonsquamous NSCLC from the United States and China public payers’ perspective. Materials and Methods A literature‐based Markov model was conducted using KEYNOTE‐189 trial data to compare cost and quality‐adjusted life years (QALYs) of three treatment strategies for nonsquamous NSCLC: Pembro‐chemotherapy combination and chemotherapy strategy without PD‐L1 test, and treatment strategy according to their PD‐L1 status. Results In base case analysis, the combination strategy generated an additional 0.78 QALYs and 0.59 QALYs over chemotherapy in the United States and China respectively, resulting in an ICER of $132 392/QALY in the United States and $92 533/QALY in China. In the PD‐L1 ≥1% base case, the ICERs were $77 754/QALY and $56 768/QALY respectively in the United States and China for PD‐L1 test strategy. In the PD‐L1 ≥50% base case, the ICERs were $44 731/QALY and $34 388/QALY respectively in the United States and China for PD‐L1 test strategy. Lowering Pembro price can also partly decrease the ICERs. Conclusion Compared with chemotherapy, the combination strategy is not cost‐effective for the treatment of NSCLC in the American and Chinese health care system at WTP threshold of $100 000/QALY for the United States and $27 351/QALY for China. Using PD‐L1 test for patient selection and price reduction could improve the cost‐effective probabilities of immunotherapy for nonsquamous NSCLC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cost‐effectiveness analysis of pembrolizumab plus chemotherapy with PD‐L1 test for the first‐line treatment of NSCLC

et al. 2020

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“…Immune checkpoint inhibitors are rapidly re‐shaping the therapeutic landscape of NSCLC in both pre‐treated and chemotherapy naïve patients (Borghaei et al, ; Brahmer et al, ; Herbst et al, ; Reck et al, ; Rittmeyer et al, ) with unprecedented results in terms of overall survival. However, the advent of this innovative class of anticancer agents brings several novel challenges in clinical practice, such as new response criteria (Seymour et al, ), novel potential patterns of progression (Champiat et al, ), undeniable high costs (Matter‐Walstra et al, ), and most importantly the need of predictive biomarkers for patients selection. PD‐L1 immunohistochemical expression is the best‐studied predictive biomarker to anti‐PD1/PD‐L1 agents.…”

Section: Discussionmentioning

confidence: 99%

Baseline neutrophilia, derived neutrophil‐to‐lymphocyte ratio (dNLR), platelet‐to‐lymphocyte ratio (PLR), and outcome in non small cell lung cancer (NSCLC) treated with Nivolumab or Docetaxel

Russo

Franchina

Ricciardi

et al. 2018

Journal Cellular Physiology

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Nivolumab is a novel therapeutic option in NSCLC, associated with a significant survival gain compared with Docetaxel. However, predictive biomarkers are lacking. The presence of systemic inflammation has been correlated with poor outcome in many cancer types. We aimed to evaluate whether there is a correlation between some indicators of inflammation and response to Nivolumab or Docetaxel in pre-treated NSCLCs. Data of 62 patients receiving Nivolumab or Docetaxel were analyzed. Baseline neutrophilia and thrombocytosis were not associated with response. High dNLR was associated with no response to Nivolumab, but not with Docetaxel, whereas high PLR correlated with low treatment response in both groups. Among refractory patients, a higher incidence of thrombocytosis, neutrophilia, high PLR, and high dNLR levels were observed compared with the overall population. This is one of the first reports in this field and suggests that indicators of inflammation might be included together with other predictive biomarkers in the baseline evaluation of patients candidate for immunotherapy.

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“…Cost-effectiveness studies suggest that the costs of many new treatments, including multiplex genomic testing, 250 novel targeted kinase inhibitors 251 and checkpoint inhibitors, are above traditional willingness-to-pay thresholds. [252][253][254] Each jurisdiction must determine its own willingness to pay for new treatments, which varies across countries and health care systems. Given that severe financial toxicity is recognized as a potential predictor of early mortality in lung and other cancers, 255 implementing strategies to ensure affordable access to treatment has never been more important for patients with lung cancer and their families.…”

Section: Mesotheliomamentioning

confidence: 99%

Scientific Advances in Thoracic Oncology 2016

Soo

Cummings

Jett

et al. 2017

Journal of Thoracic Oncology

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Lung cancer care is rapidly changing with advances in genomic testing, the development of next-generation targeted kinase inhibitors, and the continued broad study of immunotherapy in new settings and potential combinations. The International Association for the Study of Lung Cancer and the Journal of Thoracic Oncology publish this annual update to help readers keep pace with these important developments. Experts in thoracic cancer and care provide focused updates across multiple areas, including prevention and early detection, molecular diagnostics, pathology and staging, surgery, adjuvant therapy, radiotherapy, molecular targeted therapy, and immunotherapy for NSCLC, SCLC, and mesothelioma. Quality and value of care and perspectives on the future of lung cancer research and treatment have also been included in this concise review.

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A Cost-Effectiveness Analysis of Nivolumab versus Docetaxel for Advanced Nonsquamous NSCLC Including PD-L1 Testing

Cited by 81 publications

References 40 publications

Cost‐effectiveness analysis of pembrolizumab plus chemotherapy with PD‐L1 test for the first‐line treatment of NSCLC

Cost‐effectiveness analysis of pembrolizumab plus chemotherapy with PD‐L1 test for the first‐line treatment of NSCLC

Baseline neutrophilia, derived neutrophil‐to‐lymphocyte ratio (dNLR), platelet‐to‐lymphocyte ratio (PLR), and outcome in non small cell lung cancer (NSCLC) treated with Nivolumab or Docetaxel

Scientific Advances in Thoracic Oncology 2016

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