To explore the effect of model parameter uncertainty on the outcomes, we conducted probabilistic analyses using Monte Carlo simulation with 500 iterations. These high costs can have consequences for patients in the form of financial toxicity, leading patients to forgo or delay care, decreasing quality of life, and putting patients at risk of bankruptcy.10,11,12,13 Aside from the direct consequences for patients, advanced NSCLC has a high incidence rate, and the widespread adoption of costly drugs could add to the increasing costs of cancer care in general. And there's another big plus. Immunotherapy is treatment that uses a person's own immune system to fight cancer. Immunotherapy has revolutionized the treatment of non-small cell lung cancer patients reaching better survival outcomes in first and second palliative setting and in unresectable stage III tumors. Front Oncol. The clinical trial also included patients who received treatment with nivolumab with or without chemotherapy (depending on PD-L1 expression level) and found nivolumab-ipilimumab combination therapy to be more efficacious than nivolumab monotherapy. Insurance often covers the cost of these medications but they are expensive often $100,000 a year with one costing . 2020. Researchers have launched a clinical trial to test an immunotherapy drug in patients who have both cancer and an autoimmune disease, such as rheumatoid arthritis, lupus, or multiple sclerosis . Immunotherapy drugs tend to have less serious side effects than chemotherapy, but they can still affect how you feel. An official website of the United States government. But I think having Stage 2, Stage 4 has really just changed my mindset. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Yang SC, Kuo CW, Lai WW, Lin CC, Su WC, Chang SM, et al.. But immunotherapy can also cause unwanted effects. UpToDate. Insinga RP, Vanness DJ, Feliciano JL, et al.. Cost-Effectiveness of Osimertinib in the First-Line Treatment of Patients With EGFR-Mutated Advanced Non-Small Cell Lung Cancer. With immunotherapy, it may take longer to see the effects of treatment as the immune system is mobilized to attack tumors. 2020. Similar to toxic effects costs, we calculated weighted averages for the disutility associated with specific toxic effect events that paralleled the frequency of events in the CheckMate 227 clinical trial (eTable 3 in the Supplement). Probabilistic sensitivity analysis comparing the cost-effectiveness of nivolumab-ipilimumab combination therapy vs chemotherapy found that, at a willingness-to-pay threshold of $100000 per QALY, chemotherapy would be the cost-effective option 99.9% of the time (Figure 4). Chemotherapy attacks all rapidly-dividing cells within the body, effectively targeting fast-growing tumors. A model cycle length of 6 weeks was chosen because ipilimumab was administered every 6 weeks and platinum-doublet chemotherapy was given every 3 weeks. The costs of grades 3 and 4 toxic effects that were incorporated into our model are summarized in eTable 2 in the Supplement. Careers, Unable to load your collection due to an error. Three first-line treatments were administered up to disease progression. Hu H, She L, Liao M, Shi Y, Yao L, Ding D, et al.. Find out more about their symptoms and when to seek emergency care. This data can be found here: N Engl J Med (2016) 375(19):1823-33; N Engl J Med (2018) 378(22):2078-92. eCollection 2022. While the treatments can be similar and even used together, they are two different and distinct therapies. Also, N+I+chemotherapy remained dominated by N+I in patients with PD-L1 < 1%. A comparative economic analysis of pegylated liposomal doxorubicin versus topotecan in ovarian cancer in the USA and the UK. Please enable it to take advantage of the complete set of features! We developed a Markov model and simulated 10,000 stage IV or recurrent NSCLC patients that met the eligibility criteria for CheckMate 227 trial in base-case analysis. Our model was also not particularly sensitive to PD-L1 expression level. Because the follow-up period of this trial was less than 4 years, we fitted the progression-free and overall survival curves with Weibull survival functions and extrapolated them to lifetime. Similar to previous cost-effectiveness studies,18,19,20 we included and evaluated only grades 3 to 5 treatment-related adverse events. Immunotherapy is sometimes given with chemotherapy. FOIA Received 2020 Nov 30; Accepted 2021 Mar 12. If you or someone you love has been diagnosed with cancer and you're wondering whether immunotherapy might hold promise, I'd encourage you to talk with your oncologist or visit the website of the National Cancer Society to find out more. B, The ICERs below the WTP threshold of $100 000 per QALY represent scenarios in which nivolumab-ipilimumab therapy would be considered cost-effective compared with chemotherapy. Neoadjuvant Immunotherapy for MSI-H/dMMR Locally Advanced Colorectal Cancer: New Strategies and Unveiled Opportunities. Health utility values are summarized in the Table along with their respective literature sources.39,42,43,44 An annual discount rate of 3% was applied to all costs and QALYs. Toxic effects costs were included as a weighted average based on the number of reported toxic effects in the clinical trial. The vertical dashed line represents the base case hazard ratio (HR) of 0.73. Treatment with nivolumab-ipilimumab combination therapy was associated with an increase in effectiveness of 0.50 QALYs from 1.18 QALYs for chemotherapy to 1.68 QALYs for nivolumab-ipilimumab combination therapy. MeSH Figure3 PARRA: There's so many times where I didn't want to go to chemo or I just wanted to just have it all stop. We also evaluated cost-effectiveness among patients with PD-L1levels of 50% or higher in a separate sensitivity analysis. All these costs were derived from relevant U.S. sources and based on the payments by the Centers for Medicare & Medicaid Services (11, 2328). The respective ICERs for patients with PD-L1 1% were $246,584 per QALY and $1,092,784 per QALY. Our base case analysis assumed that patients received nivolumab-ipilimumab combination therapy until disease progression, unacceptable toxic effects, or 24 months of follow-up. Cancer cells adapt, building resistance to targeted therapies. When considering the cost-effectiveness of nivolumab-ipilimumab combination therapy for the treatment of other cancer types, the regimen was found to be cost-effective for patients with advanced renal cell carcinoma depending on the willingness-to-pay threshold used.20,31,52 However, for the treatment of advanced melanoma53,54,55 and metastatic colorectal cancer,56 nivolumab-ipilimumab combination therapy was not found to be cost-effective compared with a variety of other treatments, including both immunotherapy and chemotherapy. However, researchers have not concomitantly compared the cost-effectiveness of chemotherapy, N+I and N+I+chemotherapy. Clipboard, Search History, and several other advanced features are temporarily unavailable. Immunotherapy drugs work by increasing the patient's own immune response. Funding 70 Years of Discovery in Cancer Immunotherapy. Accessed October 9, 2020. Bethesda, MD 20894, Web Policies Similar ICER results were also recognized in two previous studies (17, 18). Chemotherapy as First-Line Therapy in Advanced Non-Small Cell Lung Cancer. 2016. Of note, our analysis considered only dual checkpoint inhibition using nivolumab-ipilimumab combination therapy compared with chemotherapy. Results of 1-Way Sensitivity Analysis. Cost-effectiveness of immune checkpoint inhibition in BRAF wild-type advanced melanoma, Cost-effectiveness of nivolumab-ipilimumab combination therapy compared with monotherapy for first-line treatment of metastatic melanoma in the United States, Cost-effectiveness of immune checkpoint inhibitors for microsatellite instabilityhigh/mismatch repairdeficient metastatic colorectal cancer. Epub 2022 Mar 26. The .gov means its official. UpToDate. 2019 Nov;24(11):1453-1461. doi: 10.1634/theoncologist.2019-0129. Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. colorectal neoplasms; cost-benefit analysis; immunotherapy; ipilimumab; nivolumab. While immunotherapy is nothing short of a. T-cell transfer therapy. Moreover, we did not account for the waste of drugs while calculating their costs. This is an open access article distributed under the terms of the CC-BY License. Sarkar RR, Gloude NJ, Schiff D, Murphy JD. . Fever. An official website of the United States government. World J Gastrointest Oncol. In 2016, the average cost for immunotherapy was $202,202, and the average cost for chemotherapy was $147,801. For $45 a month, Mira can provide you with affordable in-person and virtual check-ups . Out-of-pocket costs will vary, depending on the Medicare plan a person has and whether or not they have supplemental. U.S. Food and Drug Administration (FDA) approved N+I for patients with PD-L1 1% (8), and the National Comprehensive Cancer Network panel extended their use for patients with PD-L1 < 1% (9). Methods: How Our Lifestyles Impact Our Risk, Rising Female Talents in Cancer Immunotherapy Research, ASCO 2023 Preview Partnering with Patients: The Cornerstone of Cancer Care and Research. The analysis was conducted from the U.S. health care sector perspective and a willingness-to-pay threshold of $150,000 per QALY was selected (20). While researchers have inferred a higher willingness-to-pay threshold, such as $300,000 per QALY (32), our results indicated that adding chemotherapy over N+I is definitely not cost-effective, and should be discouraged. What are the main differences between the two treatments? Cost-Effectiveness of Nivolumab-Ipilimumab Combination Therapy for the Treatment of Advanced Non-Small Cell Lung Cancer. Accessed October 9, 2020. Immunotherapy treatments tend to be much gentler on the body, and have fewer harsh side effects, than chemotherapy. Sometimes patients, particularly those with a history of autoimmune disorders, will find that immunotherapy overstimulates their immune system. We compared the modeled overall survival with the trial results. The .gov means its official. This modeling analysis found that both single and dual checkpoint blockade could be significantly more effective for MSI-H/dMMR mCRC than chemotherapy, but they were not cost-effective, largely because of drug costs. The .gov means its official. When we assumed that all patients alive at the end of the study (42 months) were cured of disease, the ICER decreased to $317300 per QALY. Conclusions Medical costs included administration cost, drug costs, costs for management of adverse events, and cost for supportive care. US Food and Drug Administration . When should I choose immunotherapy vs. chemotherapy? Published: May 3, 2021. doi:10.1001/jamanetworkopen.2021.8787. Every patient should determine, in consultation with their oncologist and care team, the cancer treatment path thats right for them, whether that be chemotherapy, immunotherapy, or a combination of these or other types of cancer treatments. UpToDate. Some blood cancers can also respond well to immunotherapy.