The aim of the study was to modelling local data on costs and health benefits of alternative immunotherapies for first-line treatment of patients with non-squamous metastatic non-small cell lung cancer (ncqNSCLS) and to make an indirect comparison of their health cost ratios and benefits based on network meta-analysis. The inputs data for the model were measured and evaluated clinical endpoints in the randomized multicentre clinical trials IM power 130, KEYNOTE 189, and Check Mate 026. Modelling data for future health benefits and costs after the end of clinical trials using Markov model had three health states, one of which is an absorbent condition. Tree Age Pro Healthcare software was used to modelling the data. Atezolizumab in combination with chemotherapy (nab-paclitaxel, carboplatin) is a cost-effective first-line therapy for patients with nsqNSCLC compared to pembrolizumab in combination with chemotherapy (pemetrexed, carboplatin) and nivolumab immunotherapy alone. A probabilistic susceptibility analysis found that the probability of atezolizumab in combination with chemotherapy being a cost-effective therapy compared to pembrolizumab in combination with chemotherapy and compared to nivolumab monotherapy was 88% and 75%, respectively. Modelling data on health benefits and costs after the end of clinical trials creates some uncertainty about therapeutic efficacy and safety in the long-term monitoring.
Travis W, Travis L, Devesa S. Lung Cancer. Cancer, 1995;75(1):191-202.
Travis W, Brambilla E, Muller-Hermelink H et al. Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart, WHO, IARC Press, 2004.
Simon G, Turrisi A. Management of Small Cell Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines, Chest, 2007,132(3), 324-339.
Национална болница по онкология. Заболяемост от рак в България, 2014 и 2015. Български нацио-нален раков регистър, 2017, vol. 25.
Subramanian J, Govindan R. Lung cancer in never smokers: a review. J Clin Oncol, 2007;25(5):561-570.
Dhillon S, Syed Y. Atezolizumab first-line combination therapy: a review in metastatic nonsquamous NSCLC. Target Oncol, 2019;14(6):759-768.
Frederickson A, Arndorfer S, Zhang I et al. Pembrolizumab plus chemotherapy for first-line treatment of metastatic nonsquamous non-small-cell lung cancer: a network meta-analysis. Immunotherapy, 2019;11(5):407-428.
Georgiev KD, Georgieva M. New pharmacological approaches in the treatment of oncological diseases. J of IMAB, 2015;21(3):818-822.
Carbone D, Reck M, Paz-Ares L et al. First-Line Nivolumab in Stage IV or Recurrent Non–Small-Cell Lung Cancer. N Engl J Med 2017;376(25):2415-2426.
Grigorov EE, Vaseva VS, Getov IN. Applied pharmacoeconomics – methodology, structuring and conduct-ing of pharmacoeconomical studies, Journal of International Scientific Publications: Economy & Business, 2013;7(1):540-551.
West H, McCleod M, Hussein M et al. Atezolizumab in combination with carboplatin plus nab-paclitaxel chemotherapy compared with chemotherapy alone as first-line treatment for metastatic non-squamous non-small-cell lung cancer (IM power 130): A multicentre, randomised, open-label, phase 3 trial. Lancet Oncol, 2019;20(7):924-937.
Gandhi L, Rodríguez-Abreu D, Gadgeel S et al. Pembrolizumab plus Chemotherapy in Metastatic Non–Small-Cell Lung Cancer. N Engl J Med, 2018;378:2078-2092.
Shtereva D. Types of methods of economic evaluations in the healthcare sector. Journal of International Scientific Publications: Economy & Business, 2010;4(4):4-11.
Criss S, Mooradian M, Watson T et al. Cost-effectiveness of Atezolizumab Combination Therapy for First-Line Treatment of Metastatic Nonsquamous Non-Small Cell Lung Cancer in the United States. JAMA Netw Open, 2019;2(9):e1911952.
Wan X-M, Luo X, Tan C-Q et al. first-line atezolizumab in addition to bevacizumab plus chemotherapy for metastatic, nonsquamous non-small cell lung cancer: a United States-based cost-effectiveness analysis. Cancer, 2019;125(20):3526-3534.
Insinga R, Vanness D, Feliciano J et al. Cost-effectiveness of Pembrolizumab in Combination With Chemotherapy Versus Chemotherapy and Pembrolizumab Monotherapy in the First-Line Treatment of Squamous Non-Small-Cell Lung Cancer in the US. Curr Med Res Opin, 2019;35(7):1241-1256.