Cost-effectiveness models of non-small cell lung cancer: A systematic literature review

Non-small cell lung cancer (NSCLC) presents a formidable global health challenge owing to significant morbidity, high mortality rates, and substantial economic burden. Recent advances in targeted therapies and immunotherapies have transformed NSCLC treatment, but efficacy varies across patients. Tailoring treatment to patients can improve outcomes and potentially improve cost-effectiveness (ie, value for money) as well. For NSCLC, cost-effectiveness must often be estimated using economic modeling, and estimates are only as good as the models. Existing cost-effectiveness models are not necessarily suitable for evaluating personalized medicines.

To identify and assess cost-effectiveness models of NSCLC.

We searched for studies indexed in PubMed and Embase from 2012 to October 2023 that described cost-effectiveness models of NSCLC. Study details were extracted, summarized, and evaluated for adherence to the Consolidated Health Economic Evaluation Reporting Standards.

We identified 237 unique models, 40% of which were published in 2022 or 2023. Despite cross-model heterogeneity, most models used the same 3 health states (progression-free survival, progressive disease, and death) combined with time-to-event equations that characterize risks. Thirty models included a diagnostic component, most of which considered guiding treatment selection using biomarkers. Adherence to the overall Consolidated Health Economic Evaluation Reporting Standards checklist was generally incomplete, and adherence to a subset of model-related questions even more so.

The large number of models that were found, almost half of which were published since 2022, underscores the importance of cost-effectiveness analysis in NSCLC. Variable adherence to best practices suggests opportunities for improvement, however, and making high-quality, open-source models available to researchers may be valuable.