ECONOMIC EVIDENCE ASSOCIATED WITH FIRST-LINE TREATMENTS FOR PATIENTS WITH PD-L1 =50% UNRESECTABLE/METASTATIC NSCLC: A SYSTEMATIC LITERATURE REVIEW
Author(s)
Jhanelle E. Gray, MD1, Ryan Thaliffdeen, MS, PharmD2, Indy Kaur Dhillon, PhD3, Marissa West, PharmD2, Alex Pashley, MChem4, Emma Worthington, BSc, MPH4, Hannah Russell, MSci5, Ankita Kaushik, PhD2.
1Moffitt Cancer Center, Tampa, FL, USA, 2Gilead Sciences, Foster City, CA, USA, 3Gilead Sciences, Stockley Park, United Kingdom, 4Costello Medical, Cambridge, United Kingdom, 5Costello Medical, Manchester, United Kingdom.
1Moffitt Cancer Center, Tampa, FL, USA, 2Gilead Sciences, Foster City, CA, USA, 3Gilead Sciences, Stockley Park, United Kingdom, 4Costello Medical, Cambridge, United Kingdom, 5Costello Medical, Manchester, United Kingdom.
OBJECTIVES: This systematic literature review (SLR) identified studies reporting economic evidence of first-line (1L) treatments for patients with unresectable/metastatic non-small cell lung cancer (mNSCLC).
METHODS: MEDLINE, Embase, National Health Service Economic Evaluation Database and Health Technology Assessment Database were searched in May 2025, supplemented by grey literature handsearches (HTA and economic websites, congresses and SLR bibliographies). Included articles reported economic evaluations of 1L treatments for patients with stage IV PD-L1 ≥50% mNSCLC, and utility or contemporary cost/resource use (CRU) data for patients with 1L mNSCLC. Quality of economic evaluations was assessed using the Drummond checklist.
RESULTS: Of 4,723 publications retrieved, 22 economic evaluation studies, 9 utility studies and 21 CRU studies were included in the SLR. For pembrolizumab monotherapy versus chemotherapy/immunotherapy+chemotherapy, incremental quality-adjusted life-years (QALYs) ranged from 0.21-2.03 (n=11); where studies allowed within-currency synthesis, incremental cost-effectiveness ratios ranged from US$97,621-147,365/QALY and €54,237-84,097/QALY. Evidence for additional QALY-based treatment comparisons was identified; however, reporting was limited. Utilities decreased as patients approached death, with an overall decline of roughly 0.25-0.35 from ≥360 to <30 days-to-death. All-cause costs were high and heterogeneous, ranging from US$10,522-44,210 per patient per month (PPPM; n=5), with NSCLC-specific costs ranging from US$2,900-26,231 PPPM (n=3). All-cause visits PPPM ranged from 1.79-6.6 for outpatient (n=4), 0.12-0.21 for inpatient (n=5) and 0.11-0.30 for emergency department (n=5). Length of stay (LoS) PPPM during the 1L treatment period was reported by one study (median: 0.71).
CONCLUSIONS: Economic evaluations modelled individuals undergoing 1L treatment for stage IV PD-L1 ≥50% mNSCLC, with the majority of identified studies evaluating pembrolizumab monotherapy. Utilities and CRU specific to this population remain poorly understood, with limited data uncovered even in the broader 1L mNSCLC setting. There is a need for further economic data to characterise the burden in this setting.
METHODS: MEDLINE, Embase, National Health Service Economic Evaluation Database and Health Technology Assessment Database were searched in May 2025, supplemented by grey literature handsearches (HTA and economic websites, congresses and SLR bibliographies). Included articles reported economic evaluations of 1L treatments for patients with stage IV PD-L1 ≥50% mNSCLC, and utility or contemporary cost/resource use (CRU) data for patients with 1L mNSCLC. Quality of economic evaluations was assessed using the Drummond checklist.
RESULTS: Of 4,723 publications retrieved, 22 economic evaluation studies, 9 utility studies and 21 CRU studies were included in the SLR. For pembrolizumab monotherapy versus chemotherapy/immunotherapy+chemotherapy, incremental quality-adjusted life-years (QALYs) ranged from 0.21-2.03 (n=11); where studies allowed within-currency synthesis, incremental cost-effectiveness ratios ranged from US$97,621-147,365/QALY and €54,237-84,097/QALY. Evidence for additional QALY-based treatment comparisons was identified; however, reporting was limited. Utilities decreased as patients approached death, with an overall decline of roughly 0.25-0.35 from ≥360 to <30 days-to-death. All-cause costs were high and heterogeneous, ranging from US$10,522-44,210 per patient per month (PPPM; n=5), with NSCLC-specific costs ranging from US$2,900-26,231 PPPM (n=3). All-cause visits PPPM ranged from 1.79-6.6 for outpatient (n=4), 0.12-0.21 for inpatient (n=5) and 0.11-0.30 for emergency department (n=5). Length of stay (LoS) PPPM during the 1L treatment period was reported by one study (median: 0.71).
CONCLUSIONS: Economic evaluations modelled individuals undergoing 1L treatment for stage IV PD-L1 ≥50% mNSCLC, with the majority of identified studies evaluating pembrolizumab monotherapy. Utilities and CRU specific to this population remain poorly understood, with limited data uncovered even in the broader 1L mNSCLC setting. There is a need for further economic data to characterise the burden in this setting.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE236
Topic
Economic Evaluation, Patient-Centered Research, Study Approaches
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Oncology