Cost-effectiveness of first-line immunotherapy combinations with or without chemotherapy for advanced non–small cell lung cancer: a modelling approach
Abstract Background Many studies have explored the cost-effectiveness of immunotherapy versus chemotherapy alone. However, there is paucity of evidence on direct pharmacoeconomic studies related to immunotherapy combinations. Thus, we aimed at assessing the economic outcomes of first-line immunother...
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BMC
2023-05-01
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| Series: | BMC Cancer |
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| Online Access: | https://doi.org/10.1186/s12885-023-10938-8 |
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| author | Wen Hui Ruomeng Song Hongyu Tao Zhixiang Gao Min Zhu Mingyue Zhang Huazhang Wu Daichen Gong Xiyan Zhang Yuanyi Cai |
| author_facet | Wen Hui Ruomeng Song Hongyu Tao Zhixiang Gao Min Zhu Mingyue Zhang Huazhang Wu Daichen Gong Xiyan Zhang Yuanyi Cai |
| author_sort | Wen Hui |
| collection | DOAJ |
| description | Abstract Background Many studies have explored the cost-effectiveness of immunotherapy versus chemotherapy alone. However, there is paucity of evidence on direct pharmacoeconomic studies related to immunotherapy combinations. Thus, we aimed at assessing the economic outcomes of first-line immunotherapy combinations in the treatment of advanced non-small cell lung cancer (NSCLC) from the Chinese health care perspective. Methods The mutual hazard ratios (HRs) of ten immunotherapy combinations and one chemotherapy regimen for the overall survival (OS) and progression-free survival (PFS) were obtained from a network meta-analysis. Based on proportional hazard (PH) assumption, adjusted OS and PFS curves were established to make the effects comparable. With the parameters of cost and utility, and of scale and shape from the fit of adjusted OS and PFS curves obtained from previous studies, a partitioned survival model was designed to estimate the cost-effectiveness of immunotherapy combinations versus chemotherapy alone. Parameter uncertainty in model inputs was assessed using one-way deterministic and probabilistic sensitivity analyses. Results The incremental cost of camrelizumab plus chemotherapy versus chemotherapy alone was $13,180.65, the lowest among all the other immunotherapy combinations. Furthermore, sintilimab plus chemotherapy (sint-chemo) provided the highest quality-adjusted life-year (QALY) benefit versus chemotherapy alone (incremental QALYs = 0.45). Sint-chemo yielded the best incremental cost-effectiveness ratio (ICER) versus chemotherapy alone (ICER = $34,912.09/QALY), at the current price. The cost-effectiveness probabilities were 32.01% and 93.91% for pembrolizumab plus chemotherapy, and atezolizumab plus bevacizumab plus chemotherapy, respectively (if the original price of the pembrolizumab, atezolizumab, and bevacizumab were decreased by 90%). Conclusions Based on the fact that there is fierce competition in the PD-1/PD-L1 market, pharmaceutical enterprises should strive for greater efficacy, and optimal pricing strategy for therapies. |
| first_indexed | 2024-03-13T10:14:22Z |
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| id | doaj.art-316e8a931f154e8eae5f836a3f825b75 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2025-03-21T04:18:39Z |
| publishDate | 2023-05-01 |
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| series | BMC Cancer |
| spelling | doaj.art-316e8a931f154e8eae5f836a3f825b752024-07-28T11:23:27ZengBMCBMC Cancer1471-24072023-05-0123111010.1186/s12885-023-10938-8Cost-effectiveness of first-line immunotherapy combinations with or without chemotherapy for advanced non–small cell lung cancer: a modelling approachWen Hui0Ruomeng Song1Hongyu Tao2Zhixiang Gao3Min Zhu4Mingyue Zhang5Huazhang Wu6Daichen Gong7Xiyan Zhang8Yuanyi Cai9West China Hospital, Sichuan UniversitySchool of Public Health, China Medical UniversityLaboratory of Oncology, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeDepartment of Pharmacy, Affiliated Central Hospital of Shenyang Medical CollegeDepartment of Health Service Management, School of Health Management, China Medical UniversityDepartment of Health Economics, School of Health Management, China Medical UniversityDepartment of Health Service Management, School of Health Management, China Medical UniversityMedical Record Department, Xiamen Humanity HospitalDepartment of Health Service Management, School of Health Management, China Medical UniversityDepartment of Health Service Management, School of Health Management, China Medical UniversityAbstract Background Many studies have explored the cost-effectiveness of immunotherapy versus chemotherapy alone. However, there is paucity of evidence on direct pharmacoeconomic studies related to immunotherapy combinations. Thus, we aimed at assessing the economic outcomes of first-line immunotherapy combinations in the treatment of advanced non-small cell lung cancer (NSCLC) from the Chinese health care perspective. Methods The mutual hazard ratios (HRs) of ten immunotherapy combinations and one chemotherapy regimen for the overall survival (OS) and progression-free survival (PFS) were obtained from a network meta-analysis. Based on proportional hazard (PH) assumption, adjusted OS and PFS curves were established to make the effects comparable. With the parameters of cost and utility, and of scale and shape from the fit of adjusted OS and PFS curves obtained from previous studies, a partitioned survival model was designed to estimate the cost-effectiveness of immunotherapy combinations versus chemotherapy alone. Parameter uncertainty in model inputs was assessed using one-way deterministic and probabilistic sensitivity analyses. Results The incremental cost of camrelizumab plus chemotherapy versus chemotherapy alone was $13,180.65, the lowest among all the other immunotherapy combinations. Furthermore, sintilimab plus chemotherapy (sint-chemo) provided the highest quality-adjusted life-year (QALY) benefit versus chemotherapy alone (incremental QALYs = 0.45). Sint-chemo yielded the best incremental cost-effectiveness ratio (ICER) versus chemotherapy alone (ICER = $34,912.09/QALY), at the current price. The cost-effectiveness probabilities were 32.01% and 93.91% for pembrolizumab plus chemotherapy, and atezolizumab plus bevacizumab plus chemotherapy, respectively (if the original price of the pembrolizumab, atezolizumab, and bevacizumab were decreased by 90%). Conclusions Based on the fact that there is fierce competition in the PD-1/PD-L1 market, pharmaceutical enterprises should strive for greater efficacy, and optimal pricing strategy for therapies.https://doi.org/10.1186/s12885-023-10938-8Cost-effectivenessNon-small cell lung cancerImmunotherapy combinationHazard ratioPartitioned survival model |
| spellingShingle | Wen Hui Ruomeng Song Hongyu Tao Zhixiang Gao Min Zhu Mingyue Zhang Huazhang Wu Daichen Gong Xiyan Zhang Yuanyi Cai Cost-effectiveness of first-line immunotherapy combinations with or without chemotherapy for advanced non–small cell lung cancer: a modelling approach BMC Cancer Cost-effectiveness Non-small cell lung cancer Immunotherapy combination Hazard ratio Partitioned survival model |
| title | Cost-effectiveness of first-line immunotherapy combinations with or without chemotherapy for advanced non–small cell lung cancer: a modelling approach |
| title_full | Cost-effectiveness of first-line immunotherapy combinations with or without chemotherapy for advanced non–small cell lung cancer: a modelling approach |
| title_fullStr | Cost-effectiveness of first-line immunotherapy combinations with or without chemotherapy for advanced non–small cell lung cancer: a modelling approach |
| title_full_unstemmed | Cost-effectiveness of first-line immunotherapy combinations with or without chemotherapy for advanced non–small cell lung cancer: a modelling approach |
| title_short | Cost-effectiveness of first-line immunotherapy combinations with or without chemotherapy for advanced non–small cell lung cancer: a modelling approach |
| title_sort | cost effectiveness of first line immunotherapy combinations with or without chemotherapy for advanced non small cell lung cancer a modelling approach |
| topic | Cost-effectiveness Non-small cell lung cancer Immunotherapy combination Hazard ratio Partitioned survival model |
| url | https://doi.org/10.1186/s12885-023-10938-8 |
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