Background
Methods
Research design
Search strategy and data sources
Inclusion and exclusion criteria
Inclusion criteria
Exclusion criteria
Data extaction
Quality assessment
Results
Results of study selection
Study characteristics
Study | Country | Study design | Mean age (years) | Male sex (%) | Model | Model Developed With Health States | Participant | Intervention | Comparison |
---|---|---|---|---|---|---|---|---|---|
Chaudhary 2021 | Canada and Sweden | Model-Based | NR | NR | Cohort-based, partitioned survival model | progression-free (PF), progressed disease (PD), and death | advanced squamous NSCLC patients | The dosage of nivolumab applied was 240 mg every 2 weeks for Sweden and 480 mg every 4 weeks for Canada. | Docetaxel |
Gao 2018 | Australia | Model-Based | NR | NR | Both Markov and partition survival model | progression-free (PF), progressed disease (PD), and death. | 260 patients with advanced or metastatic squamous nonsmallcell Lung cancer | Nivolumab 3 mg/kg, per 2 weeks | Docetaxel |
Goeree 2016 | Canada | Model-Based | NR | NR | Both Markov and partition survival model | progression-free (PF), progressed disease (PD), and death. | 272 advanced squamous NSCLC patients who have failed one prior platinum doublet-based chemotherapy treatment. | Nivolumab | Docetaxel |
Chouaid 2019 | France | Model-Based | 65 | 61.3 | Cohort-based, partitioned survival model | progression-free (PF), progressed disease (PD), and death | 55 adults, diagnosed with metastatic NSCLC | Pembrolizumab | Platinum agents |
Rothwell 2021 | UK | Model-Based | NR | NR | Cohort-based, partitioned survival model | progression-free (PF), progressed disease (PD), and death | Adults with advanced or metastatic squamous NSCLC after failure of prior platinum doublet-based chemotherapy | nivolumab 3 mg/kg every 2 weeks | docetaxel |
Hu 2023 | China | Model-Based | NR | NR | Cohort-based, partitioned survival model | progression-free (PF), progressed disease (PD), and death | advanced squamous NSCLC patients | Nivolumab | Docetaxel |
Zhao 2023 | China | Model-Based | NR | NR | Cohort-based, partitioned survival model | progression-free (PF), progressed disease (PD), and death | Chinese adults (aged ≥ 18 years) who had pathologically confirmed stage IIIB–IV wild-type sqNSCLC with unlimited PD-L1 expression. | paclitaxel and platinum combined with camrelizumab | cisplatin or carboplatin combined with gemcitabine, docetaxel, or paclitaxel |
Cheng 2022 | China | Model-Based | NR | NR | Markov model | PFS, first disease progression, second disease progression, end-stage disease, and death | patients with driver-negative advanced or metastatic sqNSCLC | First-line sintilimab | Second-line sintilimab |
Insinga 2019 | USA | Model-Based | NR | NR | Cohort-based, partitioned survival model | progression-free (PF), progressed disease (PD), and death | patients with squamous metastatic (stage 4) NSCLC tumor and are eligible for first-line systemic chemotherapy. | Pembrolizumab(200 mg, once every 3 weeks) plus chemotherapy | carboplatin and paclitaxel or nab-paclitaxel |
Liu 2022 | China | Model-Based | NR | NR | Markov model | progression-free (PF), progressed disease (PD), and death | squamous NSCLC patients | Pembrolizumab + chemotherapy | Pembrolizumab |
Zhou 2023 | China | Model-Based | NR | NR | Markov model | progression-free (PF), progressed disease (PD), and death | squamous NSCLC patients | toripalimab with chemotherapy | placebo with chemotherapy |
Li 2022 | China | Model-Based | NR | NR | Markov model | progression-free (PF), progressed disease (PD), and death | squamous NSCLC patients | sugemalimab(1,200 mg, once every 3 weeks) plus chemotherapy | placebo plus chemotherapy |
Chen 2022 | China | Model-Based | A: 61.48 B: 65.00 C: 65.00 | A: 91.60 B: 81.40 C: 81.40 | Cohort-based, partitioned survival model | progression-free (PF), progressed disease (PD), and death | stage III or IV squamous NSCLC patients | Sintilimab 200 mg every 3 weeks in combination with gemcitabine and either cisplatin or carboplatin for four cycles | Pembrolizumab 200 mg plus carboplatin and paclitaxel/nabpaclitaxel every 3 weeks |
Shao 2022 | China | Model-Based | NR | NR | Cohort-based, partitioned survival model | progression-free (PF), progressed disease (PD), and death | stage IIIB-IV sq-NSCLC patients | camrelizumab (200 mg) + carboplatin + paclitaxel | Placebo + carboplatin + paclitaxel |
Zhang 2023 | China | Model-Based | 63 | 79.9 | Cohort-based, partitioned survival model | progression-free (PF), progressed disease (PD), and death | those in the clinical trial in that all patients were treatment-naive, locally progressed or metastatic NSCLC | toripalimab 240 mg in combination with standard chemotherapy | placebo once per cycle in combination with standard chemotherapy |
Main conclusion of the included studies
Study | Main Conclusion |
---|---|
Chaudhary (2021) | Trial data demonstrated that nivolumab is associated with increased OS and response rates compared with docetaxel in patients with advanced pre-treated squamous, and suggested that nivolumab generates more favorable ICERs |
Gao (2018) | The treatment with nivolumab cannot be considered cost-effective. |
Goeree (2016) | For patients with advanced squamous NSCLC, nivolumab was found to have the highest expected per patient cost, but also higher LYs and QALYs compared to docetaxel. |
Chouaid (2019) | Pembrolizumab appears cost-effective versus chemotherapy for first-line treatment of PD-L1positive (50%) metastatic NSCLC patients |
Rothwell (2021) | Nivolumab versus docetaxel is cost effective for treating locally advanced/metastatic squamous NSCLC |
Hu (2023) | Nivolumab yielded survival and quality-adjusted survival benefits at incremental cost versus docetaxel in aNSCLC. |
Zhao (2023) | Paclitaxel and platinum combined with camrelizumab are the cost-effective treatment |
Cheng (2022) | For Chinese patients with driver-negative advanced or metastatic sqNSCLC, reserving the use of sintilimab until the second-line represents a cost-effective treatment strategy compared with the first-line treatment. |
Insinga (2019) | The addition of pembrolizumab to chemotherapy is projected to approximately double life expectancy, and can be a cost-effective first-line treatment for eligible metastatic squamous NSCLC patients for whom chemotherapy is currently administered. |
Liu (2022) | For the squamous NSCLC patient population, the first-line Pembro + Chemo as a cost-effective treatment. |
Zhou (2023) | Toripalimab plus chemotherapy was an optimal choice as first-line treatment. |
Li (2022) | Sugemalimab plus chemotherapy was not cost-effective in comparison to placebo plus chemotherapy as first-line treatment for NSCLC, regardless of PD-L1 tumor expression level and pathological subtype. |
Chen (2022) | Compared with pembrolizumab + chemotherapy, sintilimab + chemotherapy is more cost-effective for first-line treatment in Chinese patients with advanced or metastatic squamous NSCLC. |
Shao (2022) | Camrelizumab plus chemotherapy was unlikely to be cost-effective compared with chemotherapy in the first line therapy of sq-NSCLC from a perspective of the Chinese healthcare system |
Zhang (2023) | Toripalimab plus chemotherapy was cost-effective compared to chemotherapy for patients with advanced NSCLC in China. |
Study | Economic Study Design | Year to Which Costs Applied | Currency Used to Which Cost Applied | Cost of Study Intervention | Cost of Study Control | Incremental Cost | Total LYs of Intervention | Total LYs of Control | Total QALYs of Intervention | Total QALYs of Control | Incremental cost per LYG | Incremental cost per QALY | |ICER| |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Chaudhary (2021) | Model-Based | 2019 | CAD and SEK | CAD 147,890 and SEK 736,478 | CAD 51,439 and SEK 201,146 | CAD 96,451 and SEK 535,333 | CAD 1.77 and SEK 2.33 | CAD 0.91 and SEK 1.29 | CAD 1.29 and SEK 1.70 | CAD 0.60 and SEK 0.95 | CAD 112,921 and SEK 417,693 | CAD 140,753 and SEK 568,895 | NA |
Gao (2018) | Model-Based | 2017 | USD | PS model: USD 137,935 and Markov model USD 100,236 | PS model: USD 119,257 and Markov model USD 22,534 | PS model: USD 118,678 and Markov model USD 77,702 | PS model: 1.51 and Markov model 1.32 | PS model: 0.86 and Markov model 0.91 | PS model: 1.06 and Markov model 1.03 | PS model: 0.86 and Markov model 0.68 | NA | NA | PS model: 17,239 and Markov model 26,570 |
Goeree (2016) | Model-Based | 2015 | USD | PS model: USD 139,017 and Markov model USD 139,016 | PS model: USD 38,849 and Markov model USD 38,812 | PS model: USD 100,168 and Markov model USD 100,204 | PS model: 1.69 and Markov model 1.68 | PS model: 0.87 and Markov model 0.87 | PS model: 1.24 and Markov model 1.23 | PS model: 0.58 and Markov model 0.58 | PS model: USD 121,905 and Markov model USD 122,834 | PS model: USD 151,560 and Markov model USD 152,229 | NA |
Hu (2023) | Model-Based | 2019 | USD | USD 478,830 | USD 264,477 | USD 214,353 | NA | NA | NA | NA | USD159,834 | USD 190,919 | 207,388 |
Insinga (2019) | Model-Based | 2018 | USD | USD 231,209 | USD 111,758 | USD 119,451 | 3.4 | 1.76 | 2.8 | 1.41 | USD72,725 | USD 86,293 | NA |
Chen (2022) | Model-Based | 2021 | USD | USD 12,321 | USD 36,371 | USD24,050 | 1.84 | 1.74 | 0.99 | 1 | NA | USD 1,314,280 | NA |
Cheng (2022) | Model-Based | 2021 | USD | USD 12,203 | USD 14,045 | USD 1842 | NA | NA | 1.37 | 1.52 | NA | USD 12,694 | NA |
Chouaid (2019) | Model-Based | 2017 | EUR | EUR 125,261 | EUR 63,229 | EUR 62,032 | 2.14 | 1.21 | 1.57 | 0.83 | NA | EUR 84,097 | 66,825 |
Liu (2022) | Model-Based | 2021 | USD | USD 153,892 | USD 150,444 | USD 3,449 | NA | NA | NA | NA | NA | USD 15,613 | NA |
Rothwell (2021) | Model-Based | 2015 | GBP | GBP 46,711 | GBP 15,430 | GBP 31,281 | NA | NA | 1.39 | 0.51 | NA | GBP 35,657 | 33,134 |
Shao (2022) | Model-Based | 2021 | USD | USD 19,165.08 | USD 12,817.27 | USD 6347.81 | 2.38 | 1.47 | NA | NA | NA | NA | 13571.68 |
Zhang (2023) | Model-Based | 2021 | USD | USD 45,268 | USD 26,768 | USD 18,501 | NA | NA | 1.4 | 0.83 | NA | NA | 32,237 |
Zhao (2023) | Model-Based | 2022 | USD | USD 19,026 | USD 18,131 | USD 895 | 2.513 | 2.219 | 1.603 | 1.283 | NA | NA | NA |
Zhou (2023) | Model-Based | 2022 | USD | USD 23,674 | USD 11,367 | USD 12,307 | NA | NA | 1.61 | 0.94 | NA | NA | 18,369 |
Li (2022) | Model-Based | 2021 | USD | USD 80,540.73 | USD 24,726.85 | USD 55,813.88 | NA | NA | 1.58 | 1 | NA | NA | 96,230.83 |
ICB monotherapy VS Chemo-based monotherapy
ICB monotherapy VS Chemo-based combination therapy
ICB-Chemo combination therapy VS chemo-based combination therapy
ICB-Chemo combination therapy VS placebo-chemo combination therapy
ICB-based therapy VS ICB-based therapy
Study sites subgroup analysis
Study quality
Drummond Checklist/Study Authors | Was a Well-Defined Question Posed in an Answerable Form? | Was a Comprehensive Description of the Competing Alternatives Given? | Was the Effectiveness of the Program Established? | Were All the Important and Relevant Costs and Consequences for Each Alternative Identified? | Were Costs and Consequences Measured Accurately in Appropriate Physical Units? | Were Costs and Consequences Valued Credibly? | Were Costs and Consequences Adjusted for Differential Timing? | Was an Incremental Analysis of Costs and Consequences of Alternatives Performed? | Was Allowance Made for Uncertainty in the Estimates of Costs and Consequences? | Did the Presentation and Discussion of Study Results Include All Issues of Concern to Users? | Total |
---|---|---|---|---|---|---|---|---|---|---|---|
Chaudhary (2021) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Gao (2018) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Goeree (2016) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Hu (2023) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Insinga (2019) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Chen (2022) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Cheng (2022) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Chouaid (2019) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Liu (2022) | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | 9 |
Rothwell (2021) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Shao (2022) | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | 9 |
Zhang (2023) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Zhao (2023) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Zhou (2023) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Li (2022) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |