The effect of PD-L1 testing on the cost-effectiveness and economic impact of immune checkpoint inhibitors for the second-line treatment of NSCLC

Aguiar, Pedro Nazareth; Perry, Luke A; Penny-Dimri, Jahan C.; Babiker, Hani M.; Tadokoro, Hakaru; Mello, Ramon Andrade De; Lopes, Gilberto

doi:10.1093/annonc/mdx305

Cited by 78 publications

(81 citation statements)

References 26 publications

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“…This analysis is subject to certain limitations. First, we were unable to estimate costs for immunotherapy drugs, which have shown promising gains in survival for some patients, because approvals for lung cancer treatment came after the end of our study period . Second, the SEER‐Medicare data used in our analysis were limited to patients over age 65 who were not simultaneously enrolled in managed care and we were unable to determine the proportion of patient‐liability costs paid out of pocket vs the portion paid by purchased Medigap coverage.…”

Section: Discussionmentioning

confidence: 99%

Lung cancer costs by treatment strategy and phase of care among patients enrolled in Medicare

et al. 2018

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BackgroundWe studied trends in lung cancer treatment cost over time by phase of care, treatment strategy, age, stage at diagnosis, and histology.MethodsUsing the Surveillance, Epidemiology, and End Results (SEER)‐Medicare database for years 1998‐2013, we allocated total and patient‐liability costs into the following phases of care for 145 988 lung cancer patients: prediagnosis, staging, surgery, initial, continuing, and terminal. Patients served as self‐controls to determine cancer‐attributable costs based on individual precancer diagnosis healthcare costs. We fit linear regression models to determine cost by age and calendar year for each stage at diagnosis, histology, and treatment strategy and presented all costs in 2017 US dollars.ResultsMonthly healthcare costs prior to lung cancer diagnosis were $861 for a 70 years old in 2017 and rose by an average of $17 per year (P < 0.001). Surgery in 2017 cost $30 096, decreasing by $257 per year (P = 0.007). Chemotherapy and radiation costs remained stable or increased for most stage and histology groups, ranging from $4242 to $8287 per month during the initial six months of care. Costs during the final six months of life decreased for those who died of lung cancer or other causes.ConclusionsCost‐effectiveness analyses of lung cancer control interventions in the United States have been using outdated and incomplete treatment cost estimates. Our cost estimates enable updated cost‐effectiveness analyses to determine the benefit of lung cancer control from a health economics point of view.

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Section: Discussionmentioning

confidence: 99%

Lung cancer costs by treatment strategy and phase of care among patients enrolled in Medicare

et al. 2018

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“…All these data are listed in Table 1. 16,[19][20][21][22][23][28][29][30][31][32] For dosage calculation in the United States and China, body surface area (BSA) and body weight of 1.84 m 2 , 71.4 kg and 1.72 m 2 , 65 kg were adopted respectively. [33][34][35]…”

Section: Health Care Resource Uses Costs and Utilitymentioning

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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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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“…IL-35 inhibited PD-L1 under metabolic deprivation in ADC tumour cell line As described above and indicated in the literature, IFNγ, a potent anti-tumour cytokine, induced PD-L1 in A549 that points out to a double role of this cytokine in tumour because anti-PD-L1 trial has demonstrated to be successful in some cases of NSCLC. 7,28 However, ADC is also signed by genetic imprints that must be considered, such as the expression of the epidermal growth factor receptor (EGFR) which binds to EGF, a potent growth factor for the ADC. [29][30][31] Therefore, we next asked whether IL-35 would regulate these pathways under growth factor deprivation.…”

Section: Il-35 Regulation Of Nsclc Cell Survivalmentioning

confidence: 99%

Increased expression of the immunosuppressive interleukin-35 in patients with non-small cell lung cancer

et al. 2019

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BACKGROUND: The immunosuppressive role of the cytokine IL-35 in patients with non-small cell lung cancer (NSCLC) is poorly understood. In this study, we analysed the localisation and regulation of IL-35 in the lung of patients with non-small cell lung cancer (NSCLC) to further elucidate the immune-escape of cancer cells in perioperative course of disease. METHODS: Interleukin 35 (IL-35) was measured by ELISA in postoperative serum from 7 patients with NSCLC as well as 8 samples from healthy controls. Immunohistochemistry, FACS analysis, real-time PCR, as well as western blot from samples of the control (CTR), peri-tumoural (PT) and the tumoural (TU) region of the lung derived from patients with NSCLC and 10 controls were performed. RESULTS: Here we found elevated levels of IL-35 in the TU region as well as postoperative serum from patients with lung adenocarcinoma. Consistently, we found an increased expression of IL-35 + Foxp-3 + cells, which associated with ARG1 mRNA expression and decreased TNFA in the TU region of the lung of patients with NSCLC as compared to their CTR region. Furthermore, in the CTR region of the lung of patients with NSCLC, CD68 + macrophages were induced and correlated with IL-35 + cells. Finally, IL-35 positively correlated with TTF-1 + PD-L1 + cells in the TU region of NSCLC patients. CONCLUSIONS: Induced IL-35 + Foxp3 + cell numbers in the TU region of the lung of patients with NSCLC associated with ARG1 mRNA expression and with TTF-1 + PD-L1 + cells. In the tumour-free CTR area, IL-35 correlated with CD68 + macrophages. Thus inhibitors to IL-35 would probably succeed in combination with antibodies against immune checkpoints like PD-L1 and PD-1 currently used against NSCLC because they would inhibit immunosuppressive macrophages and T regulatory cells while promoting T cell-mediated anti-tumoural immune responses in the microenvironment as well as the TU region of NSCLC patients.

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The effect of PD-L1 testing on the cost-effectiveness and economic impact of immune checkpoint inhibitors for the second-line treatment of NSCLC

Abstract: The use of PD-L1 expression as a biomarker increases cost-effectiveness of immunotherapy but also diminishes the number of potential life-years saved.

Cited by 78 publications

References 26 publications

Lung cancer costs by treatment strategy and phase of care among patients enrolled in Medicare

Lung cancer costs by treatment strategy and phase of care among patients enrolled in Medicare

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

Increased expression of the immunosuppressive interleukin-35 in patients with non-small cell lung cancer

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