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Pharmacoeconomic Evaluation of PD-L1 Receptor Inhibitors for the Second Line Treatment of Metastatic Non-Small Cell Lung Cancer

Issue № 32 | 2018 (2)

DOI: https://doi.org/10.31556/2219-0678.2018.32.2.067-080 meta

Abstract

Lung cancer is the most common malignant tumor and the most prevalent cause of cancer-related deaths in Russian men. Programmed-cell-death 1 (PD-1) inhibitors pembrolizumab and nivolumab are the new treatment options for metastatic non-small cell lung cancer (NSCLC) that improve treatment outcomes compared to docetaxel.

Objective of the study: the pharmacoeconomic evaluation of PD-1 inhibitors for the 2nd line treatment of patients with metastatic NSCLC with disease progression on or after platinum-containing chemotherapy or anti-EGFR/ALK targeted therapy drugs in Russia.

Methods. We compared two treatment options: use of pembrolizumab (for patients whose tumors express PD-L1) or docetaxel (for other patients) vs use of nivolumab regardless of PD-L1 expression level. We proposed a Markov chain model of NSCLC progression based on data from clinical trials. We calculated direct medical costs associated with two treatment options, and conducted budget impact and cost-effectiveness analyses.

Results. Medication cost of pembrolizumab or docetaxel option were 3,980,925.27 RUB per patient per year, which was 27 % less than for nivolumab (5,436,657.87 RUB). Five-year direct medical costs of using pembrolizumab (for a patient whose tumor expresses PD-L≥1%) or docetaxel (for other patients) were 2,775,253 RUB, or 35.2% less than for nivolumab. Pembrolizumab or docetaxel option also had lower (better) cost/effectiveness ratio. Compared to nivolumab, pembrolizumab or docetaxel can save up to 11.9 billion RUB (32.5%) budget expenditures in three years.

Keywords

non-small cell lung cancer, pembrolizumab, nivolumab, docetaxel, pharmacoeconomic evaluation, cost-effectiveness analysis, budget impact analysis.

For citations

Avxentyev N. A., Zhuravleva M. V., Makarov A. S., Semiglazova T. Yu., Frolov M. Yu. Pharmacoeconomic Evaluation of PD-L1 Receptor Inhibitors for the Second Line Treatment of Metastatic Non-Small Cell Lung Cancer. Medical Technologies. Assessment and Choice. 2018; 2(32): 67–80.

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