OBJECTIVES: Since 2015, several immuno-oncology agents (IOs) have been approved for NSCLC. This SLR assessed studies on costs and healthcare resource utilization (HCRU) associated with IOs as 1L treatments in advanced/metastatic NSCLC.

METHODS: This SLR followed PRISMA guidelines and a predesigned protocol. MEDLINE, Embase, EconLit (Jan 2008-Jan 2020), and relevant conferences (since 2016) were searched to identify economic studies of IOs in NSCLC published in English. Screening and data extraction were conducted by 2 reviewers.

RESULTS: Of 1,456 studies identified, 9 cost and HCRU studies on IOs met the inclusion criteria. All studies used claims databases from 2008–2018, and all but 2 had a US perspective.

Five studies compared costs of IOs with chemotherapies (CTx) or costs before and after IO introduction, using different cost measures, including per-patient per-month (PPPM) cost, total medical cost, cost of adverse events (AEs), or budget impact. One study showed the mean PPPM cost was $41,815 for IOs and $24,515 for CTx, and another study reported a mean total cost of $64,500 with nivolumab vs $34,971 with CTx. However, a study assessing the economic impact of IO introduction found a small difference in the PPPM cost ($12,123 [pre-IOs] vs $12,028 [post-IOs]). Adjusting for treatment duration, costs of AEs were lower with IOs than with CTx.

Five studies assessed HCRU with IOs. Hospitalization rate was lower in IO-treated patients (25%-29%) than in patients treated with IO-CTx combinations (35%) or CTx (37%). Statistically significantly fewer hospitalizations and emergency department visits were reported post IO (p<0.001).

CONCLUSIONS: The economic impact of IOs due to increased drug costs appears balanced by lower HCRU and AE management cost. However, the evidence was limited and US-focused. Given recent approvals of newer single-agent and combination IOs, future studies should further assess the economic impact of IOs in patients with advanced/metastatic NSCLC.