OBJECTIVES:

With the availability of new treatment options for aNSCLC (ie; immunotherapies [ICIs]), there has been an increase in healthcare costs despite dramatically improved survival outcomes. A TLR was performed to evaluate the economic burden and cost-effectiveness of aNSCLC treatments and identify evidence gaps.

METHODS:

Literature published between January 2016 - January 2021 was identified by searching MEDLINE, Embase, and NHS Economic Evaluations Databases. Publications evaluating adult patients (≥18 years) with treatment-naïve aNSCLC (stage IIIB/C and stage IV) not eligible for targeted therapy were included.

RESULTS:

After screening 5,464 records, 20 relevant publications were included (7 healthcare cost/utilization; 13 cost-effectiveness analyses). In the US, costs pre-approval were higher than post-approval of ICIs for total direct healthcare (1L: $87,890±$96,925 vs. $80,206±$69,033; p=0.011), hospitalization (1L: $22,296±$69,506 vs. $14,406±$20,981; p=0.009), and emergency department (ED) visits (1L: $30,236±$44,805 vs. $20,432±$22,600; p<0.001). The costs associated with stage of disease were lower for early stage disease; however, costs were comparable for aNSCLC. Mean wage loss for patients diagnosed with aNSCLC were significantly higher for stage IV disease compared to stage IIIB (€2282 vs €499; p = 0.0135) and the financial burden was most impactful on patients and caregivers. Cost-effectiveness of ICIs alone or in combination varied by country and did not change significantly based on PD-L1 expression.

CONCLUSIONS:

Despite the increased cost of ICIs compared to other available treatments, the lower costs of hospitalization resulted in a favorable effect on the total cost of care for aNSCLC. Overall, cost-effectiveness studies reported that ICIs were cost effective. Indirect cost data indicate that the financial burden of aNSCLC on patients and caregivers is considerable and influenced by disease stage. As aNSCLC patients respond to new treatments and live longer, the societal impact remains to be characterized and more research should be conducted to fill this knowledge gap.