Patients with advanced lung cancer are considered to have a poor prognosis, and recent studies have shown that immunotherapy appears to be associated with improved prognosis and prolonged survival significantly compared with chemotherapy. However, immunotherapy may refer to a comparatively high medical cost and bring severe financial toxicity to patients. In the treatment course of patients with advanced lung cancer, much attention was paid to the safety and efficacy of medications, rather than financial toxicity, which may affect the prognosis and survival indeed. In that case, it is necessary to weigh the profit and the financial toxicity led by immunotherapy.
We performed a systematic search in Medline on the cost-effectiveness of immunotherapy in patients with advanced lung cancer, and 16 studies were included, consisting of 6 countries, We systematically reviewed the incremental cost for improved quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) in patients treated with immunotherapy with respect to different countries and different tumor proportion score (TPS) of programmed death receptor-1 ligand (PD-L1).
We found that the willingness to pay (WTP) was not significantly associated with ICER among three western countries (P=0.354). Patients with TPS ≥50%, ≥20%, or ≥1% showed no significant differences in elevated QALYs (P=0.148) and ICER (P=0.263). The elevated QALYs (P=0.024) and ICER of Pembrolizumab were significantly higher than that of Atezolizumab (P=0.045), while there was no significant difference in the cost of elevated QALY between Pembrolizumab and Atezolizumab (P=0.747).
Patients with advanced lung cancer would get profit in the treatment of immunotherapy from different countries, while Pembrolizumab would be associated with a higher benefit and less financial toxicity when taking cost-effectiveness analysis into account. Thus, patients would get more in the immunotherapy when financial toxicity was taken into consideration, and it is necessary to integrate financial toxicity in the clinical decision.
The authors.
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All authors have declared no conflicts of interest.