Real-World Effectiveness and Cost-Utility Analysis of Second-Line Immunotherapy for Non-Oncogene-Addicted Advanced...

Area of Science:

• Oncology
• Health Economics
• Pharmacoeconomics

Background:

• Advanced non-small cell lung cancer (NSCLC) presents significant treatment challenges.
• Immune checkpoint inhibitors (ICIs) have emerged as a promising second-line therapy.
• Evaluating the cost-effectiveness of ICIs in real-world settings is crucial for healthcare policy.

Purpose of the Study:

• To assess the cost-effectiveness of second-line immune checkpoint inhibitors (ICIs) versus chemotherapy for advanced non-small cell lung cancer (NSCLC).
• To utilize real-world patient-level data on treatment effectiveness, costs, and utility.
• To analyze outcomes from a societal perspective in Thailand.

Main Methods:

• Retrospective review of medical records for 209 patients with advanced NSCLC (72 on ICIs, 137 on chemotherapy).
• Prospective interviews to gather utility and non-medical cost data.
• Application of a semi-Markov model for lifetime cost-effectiveness analysis, including sensitivity and scenario analyses.

Main Results:

• Second-line ICIs significantly improved overall survival (HR 0.64) and quality-adjusted life-years (QALYs) gained (0.57).
• The incremental cost-effectiveness ratio (ICER) for second-line ICIs was $30,104 USD/QALY.
• ICIs were more cost-effective for healthier patients (ECOG 0-1) with an ICER of $9,856 USD/QALY, still above Thailand's threshold ($4,444 USD/QALY).

Conclusions:

• Second-line ICIs demonstrate improved survival outcomes in advanced NSCLC.
• Current pricing makes second-line ICIs not cost-effective in Thailand.
• Strategies like drug price negotiation and prioritizing specific patient subgroups are recommended to improve accessibility.