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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

2017-09Journal article Open access
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dc.contributor.authorAguiar, P. N., Jr.
dc.contributor.authorPerry, L. A.
dc.contributor.authorPenny-Dimri, J.
dc.contributor.authorBabiker, H.
dc.contributor.authorTadokoro, H.
dc.contributor.authorde Mello, R. A.
dc.contributor.authorLopes, G. L., Jr.
dc.date.accessioned2018-12-07T14:58:12Z
dc.date.available2018-12-07T14:58:12Z
dc.date.issued2017-09
dc.description.abstractBackground: Immune checkpoint inhibitors improve outcomes compared with chemotherapy in lung cancer. Tumor PD-L1 receptor expression is being studied as a predictive biomarker. The objective of this study was to assess the cost-effectiveness and economic impact of second-line treatment with nivolumab, pembrolizumab, and atezolizumab with and without the use of PD-L1 testing for patient selection. Design: We developed a decision-analytic model to determine the cost-effectiveness of PD-L1 assessment and second-line immunotherapy versus docetaxel. The model used outcomes data from randomized clinical trials (RCTs) and drug acquisition costs from the United States. Thereafter, we used epidemiologic data to estimate the economic impact of the treatment. Results: We included four RCTs (2 with nivolumab, 1 with pembrolizumab, and 1 with atezolizumab). The incremental quality-adjusted life year (QALY) for nivolumab was 0.417 among squamous tumors and 0.287 among non-squamous tumors and the incremental cost-effectiveness ratio (ICER) were $155 605 and $187 685, respectively. The QALY gain in the base case for atezolizumab was 0.354 and the ICER was $215 802. Compared with treating all patients, the selection of patients by PD-L1 expression improved incremental QALY by up to 183% and decreased the ICER by up to 65%. Pembrolizumab was studied only in patients whose tumors expressed PD-L1. The QALY gain was 0.346 and the ICER was $98 421. Patient selection also reduced the budget impact of immunotherapy. Conclusion: The use of PD-L1 expression as a biomarker increases cost-effectiveness of immunotherapy but also diminishes the number of potential life-years saved.
dc.description.versioninfo:eu-repo/semantics/publishedVersion
dc.identifier.doi10.1093/annonc/mdx305
dc.identifier.issn0923-7534
dc.identifier.issn1569-8041
dc.identifier.urihttp://hdl.handle.net/10400.1/11907
dc.language.isoeng
dc.peerreviewedyes
dc.publisherOxford University Press
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectCell lung-cancer
dc.subjectPredictive biomarker
dc.subjectNext-generation
dc.subjectBreast-cancer
dc.subjectNivolumab
dc.subjectChemotherapy
dc.subjectExpression
dc.subjectDocetaxel
dc.subjectImmunotherapy
dc.subjectPembrolizumab
dc.titleThe effect of PD-L1 testing on the cost-effectiveness and economic impact of immune checkpoint inhibitors for the second-line treatment of NSCLC
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage2263
oaire.citation.issue9
oaire.citation.startPage2256
oaire.citation.titleAnnals of Oncology
oaire.citation.volume28
person.familyNamede Mello
person.givenNameRamon Andrade
person.identifier.orcid0000-0002-9640-4573
rcaap.rightsopenAccess
rcaap.typearticle
relation.isAuthorOfPublication53ee625f-c5c3-468b-85bb-4cef5ad36928
relation.isAuthorOfPublication.latestForDiscovery53ee625f-c5c3-468b-85bb-4cef5ad36928

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