OBJECTIVES: Non-small cell lung cancer (NSCLC) comprises a sizeable majority of lung cancer cases. The objectives of this study are: 1) summarize the economic evidence landscape; and 2) characterize the scope of HTA assessments for 1L treatments targeting advanced and metastatic NSCLC.

METHODS: A systematic literature search was conducted using Embase, Medline, and Medline in Process to identify original articles published between 1/1/2012 and 6/13/2022. Studies were included if they published results from an economic evaluation of 1L treatment in adults with locally advanced and/or metastatic NSCLC in French, German, Italian, Spanish, or UK settings. Outcomes of interest included model structure and population, data sources, interventions and comparators, and cost per QALY.

RESULTS: In total 19 full-text publications, 11 conference abstracts, and 15 HTA assessments were included. The majority (n= 11) of included publications were cost-effectiveness analyses using a partitional survival model with 3 health states: progression-free survival, disease progression, and death. Time horizons ranged from 1 year to a lifetime. The most frequently evaluated therapies for cost-effectiveness were pembrolizumab monotherapy or combination with chemotherapy (n=9) compared to platinum-based chemotherapy or nivolumab; and erlotinib (n=6) compared to best supportive care or chemotherapy. Patient populations from France and Spain were the most frequently evaluated, and were heterogenous with limited evidence for subtypes. Clinical data such as population characteristics, overall and progression free survival, and adverse event incidence, were sourced from 15 clinical trials; with utility mostly estimated using EQ-5D data collected during the trials. Base-case ICERs from cost-effectiveness and cost-utility studies were most sensitive to assumptions around survival estimates and drug, with pembrolizumab generally considered to be a cost-effective 1L treatment.

CONCLUSIONS: Overall, 1L cost-effectiveness varied depending on study design and country settings. Challenges such as heterogeneity in trial populations and survival extrapolation should be considered for future economic evaluations in advanced or metastatic NSCLC.