Economic Evaluations of First-Line Non-Small Cell Lung Cancer Therapies: A Systematic Review With Focus on PD-L1 Subgroups

Author(s)

Nadia Karim, MSc1, Vidhi Patel, MSc2, Thomas Macmillan, MSc3, Ihtisham Sultan, PhD4, Björn Stollenwerk, PhD5.
1Amgen Ltd., Uxbridge, United Kingdom, 2Cytel, Toronto, ON, Canada, 3Cytel Inc., London, United Kingdom, 4Amgen Inc., Thousand Oaks, CA, USA, 5Amgen (Europe) GmbH, Rotkreuz, Switzerland.
OBJECTIVES: First line treatment for advanced or metastatic non-small cell lung cancer (a/m NSCLC) has progressed with the introduction of immune checkpoint inhibitors and combination therapies. This systematic literature review aimed to summarize published economic evaluations, including cost-effectiveness analyses (CEAs) and budget impact models (BIMs), focusing on the economic value of therapies across PD-L1 subgroups.
METHODS: A systematic search of Embase, MEDLINE, NHS EED, EconLit, Health Technology Assessments, and grey literature (January 2018-March 2024) identified studies reporting CEAs or BIMs of first line therapies in adults with a/m NSCLC. Data was extracted on model type, perspective, time horizon, inputs, outcomes, and subgroup analyses. Findings were synthesized narratively.
RESULTS: Seventy economic evaluations were identified: 60 CEAs and 10 BIMs. Most CEAs were conducted in North America (n=46) or Europe (n=13), using Markov (n=32) or partitioned survival models (n=25). Time horizons ranged from 3 years to lifetime (commonly 20 years). Drug costs, utility values, and overall survival were key drivers. PD-L1 subgroup analyses were reported in 37 CEAs, with 32 evaluating PD-L1 ≥50%, 8 evaluating PD-L1 1-49% and 12 evaluating PD-L1 <1%. Immunotherapies were generally cost-effective versus chemotherapy in PD-L1-positive populations, though results were more variable in PD-L1-negative groups. Cemiplimab and nivolumab + ipilimumab were frequently cost-effective compared with chemotherapy, while pembrolizumab showed mixed results depending on PD-L1 level, country, and comparator. Combination therapies (e.g., pembrolizumab plus chemotherapy) were often not cost-effective at conventional thresholds compared with chemotherapy or immunotherapy alone. Among 10 BIMs, agents such as cemiplimab, toripalimab, and atezolizumab were evaluated, with outcomes influenced by PD-L1 distribution, country-specific assumptions, and treatment duration.
CONCLUSIONS: Economic evaluations of 1L NSCLC therapies consistently apply Markov or partitioned survival models with long-term horizons. Immunotherapy regimens are often cost-effective in PD-L1-enriched populations, though uncertainty remains in PD-L1-negative subgroups. BIMs emphasize the impact of pricing, uptake, and duration on affordability.

Conference/Value in Health Info

2025-11, ISPOR Europe 2025, Glasgow, Scotland

Value in Health, Volume 28, Issue S2

Code

EE391

Topic

Economic Evaluation, Study Approaches

Disease

Oncology

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