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First-line ICI monotherapies for advanced non-small-cell lung cancer patients with PD-L1 of at least 50%: A cost-effectiveness analysis


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Liu, Q, Zhou, Z ORCID: 0000-0002-0835-8686, Luo, X, Yi, L, Peng, L, Wan, X, Tan, C and Zeng, X 2021 , 'First-line ICI monotherapies for advanced non-small-cell lung cancer patients with PD-L1 of at least 50%: A cost-effectiveness analysis' , Frontiers in Pharmacology, vol. 12 , pp. 1-10 , doi: 10.3389/fphar.2021.788569.

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Objective: Three immune checkpoint inhibitors (ICIs), pembrolizumab, atezolizumab and cemiplimab, have been successively approved as first-line treatments for advanced non-small-cell lung cancer (NSCLC) patients with programmed cell death ligand 1(PD-L1) expression of at least 50%. This study was designed to compare the cost-effectiveness of these three novel therapies in this patient population.Material and Methods: Using Markov model and network meta-analysis, we conducted separate cost-effectiveness analyses for cemiplimab, pembrolizumab and atezolizumab among advanced NSCLC patients with PD-L1 of at least 50% from the United States health care sector perspective. Health states included progression-free survival, progressive disease, end-stage disease, and death. Clinical efficacy and safety data were derived from phase III clinical trials and health state utilities and costs data were collected from published resources. Two scenario analyses were conducted to assess the impact of varying subsequent anticancer therapies on the cost-effectiveness of these 3 ICIs and cost-effectiveness of pembrolizumab combined with chemotherapy versus these 3 first-line ICI monotherapies.Results: In base case analysis, cemiplimab compared with pembrolizumab was associated with a gain of 0.44 quality-adjusted life-years (QALYs) and an increased cost of $23,084, resulting in an incremental cost-effectiveness ratio (ICER) of $52,998/QALY; cemiplimab compared with atezolizumab was associated with a gain of 0.13 QALYs and a decreased cost of $104,642, resulting in its dominance of atezolizumab. The first scenario analysis yielded similar results as our base case analysis. The second scenario analysis founded the ICERs for pembrolizumab plus chemotherapy were $393,359/QALY, $190,994/QALY and $33,230/QALY, respectively, compared with cemiplimab, pembrolizumab and atezolizumab.Conclusion: For advanced NSCLC patients with PD-L1 of at least 50%, cemiplimab was a cost-effective option compared with pembrolizumab and a dominant alternative against atezolizumab. Our scenario analysis results supported the cemiplimab plus chemotherapy as a second-line therapy and suggested an extended QALY but overwhelming cost linking to pembrolizumab plus chemotherapy.

Item Type: Article
Authors/Creators:Liu, Q and Zhou, Z and Luo, X and Yi, L and Peng, L and Wan, X and Tan, C and Zeng, X
Keywords: non-small cell lung cancer, PD-L1 expression, cemiplimab, pembrolizumab, atezolizumab, cost effectiveness
Journal or Publication Title: Frontiers in Pharmacology
Publisher: Frontiers Research Foundation
ISSN: 1663-9812
DOI / ID Number: 10.3389/fphar.2021.788569
Copyright Information:

Copyright © 2021 Liu, Zhou, Luo, Yi, Peng, Wan, Tan and Zeng. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) License ( The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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