OBJECTIVES:

The 5-year survival rate of metastatic (m) non-small-cell lung cancer (NSCLC) is ~7% across Europe (EU). Immune checkpoint inhibitors have resulted in a paradigm shift in mNSCLC treatment landscape. Beside the required clinical outcomes, economic impact must be evaluated, considering the high cost of immunotherapies. We aimed to evaluate the published cost-effectiveness studies to understand the importance of immunotherapies in mNSCLC in EU-5, Sweden and Switzerland, and their role in decision making.

METHODS:

Electronic databases such as PubMed, EMBASE, and Cochrane were used. The search was limited to English language, last conducted on 28 June 2022, with a 5-year and country filter. Costs were reported in local currencies and effectiveness as quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER).

RESULTS:

Sixteen cost-effectiveness studies were identified, of which fifteen were from a healthcare payer perspective. First‑line (1L) pembrolizumab monotherapy in mNSCLC patients without driver mutations, resulted in QALY gains (range 0.74–1.34) versus platinum-based chemotherapy (n=4). At a specified willingness-to-pay threshold, the probability of pembrolizumab being cost-effective was 80%, 88%, and 29% in France, Switzerland, and the UK, respectively. Durvalumab consolidation following chemoradiotherapy was also estimated to be cost-effective, with an increase in mean QALYs in Italy (2.73), Switzerland (1.18), and the UK (2.51). Similarly, nivolumab monotherapy and nivolumab + ipilimumab was shown to be cost-effective in Sweden, the UK and Spain, respectively. Among 1L treatments, pembrolizumab was more cost-effective versus nivolumab in Germany, Italy, and Spain. For second-line (2L), atezolizumab was more efficient (+0.47 QALYs) and costlier (€49,429) than docetaxel in the treatment of mNSCLC in France (ICER: €104,835/QALY).

CONCLUSIONS:

Our targeted review summarises the cost-effectiveness of immunotherapies in mNSCLC in selected EU nations. However, further research is needed to demonstrate how these pharmacoeconomic analyses can guide clinicians/policymakers in the timely adoption of these therapies to maximise patient benefit.