Portal de Periódicos da CAPES

Artigo Acesso aberto Produção Nacional Revisado por pares

BIBTEX RIS

O.03: Cost Effectiveness of Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer Relative to PD-L1 Expression

2016; Elsevier BV; Volume: 11; Issue: 10 Linguagem: Inglês

10.1016/j.jtho.2016.08.006

1556-1380

Pedro Nazareth Aguiar, Ramon Andrade de Mello, Hakaru Tadokoro, Ilka Lopes Santoro, Hani M. Babiker, Kiran Avancha, Bárbara de Souza Gutierres, Carmélia Maria Noia Barreto, Gilberto Lopes,

Cancer Genomics and Diagnostics

Recent clinical trials have shown that immune checkpoint inhibitors are active against several neoplasms, including lung cancer. Tumor PD-L1 receptor expression is being studied as a predictive biomarker. The objective of our study is to assess the cost-effectiveness and economic impact of nivolumab and pembrolizumab with and without the use of PD-L1 as a biomarker. We developed a decision-analytic model to determine the cost-effectiveness of PD-L1 assessment and second-line treatment with NIVO or PEMBRO versus docetaxel. The model used outcomes data from randomized clinical trials and drug acquisition costs from the United States. We also included the costs of adverse events and post-progression therapies. Published utility values were used. Health effects were expressed as quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER) were calculated. We included three RCTs (two with NIVO and one with PEMBRO). Among all patients with squamous histology, the incremental QALY of NIVO was 0.23. The ICER was US$ 128,000. PD-L1 expression improved incremental QALY only for patients with PD-L1 > 5% and > 10% (by 15% and 18% respectively). Among all patients with non-squamous histology, the incremental QALY of NIVO was 0.12. The ICER was US$ 121,000. PD-L1 expression improved incremental QALY for patients with PD-L1 > 1%, > 5% and > 10% (by 67%, 157% and 137%, respectively). This lead to an ICER drop (US$ 72,000, 47,000 and 51,000, respectively). KeyNote-010 included 30% of patients at the third-line of treatment, all patients treated with PEMBRO had at least 1% of PD-L1 expression; the incremental QALY was 0.13. The ICER was US$ 116,000. PD-L1 expression above 50% improved QALY by 18% and the ICER was US$ 98,000. Use of PDL1 expression as a biomarker may increase the cost-effectiveness of treatment with immune checkpoint inhibitors and further validation is warranted.