Cost-utility analysis of Immuno-Oncotherapy in chemotherapy-pretreated, recurrent, non-small cell lung cancer in Thailand

Abstract

Introduction: Lung cancer is the most common cancer in males and the fourth most common in females. Although there are many novel effective treatments available on the market, patients are mainly unable to access them. The biggest barrier factor is the cost of treatment which may cause financial toxicity to the patients, family, or even to the healthcare system, especially in low or middle-income countries. This study aims to (1) evaluate the cost-effectiveness of applying immune checkpoint inhibitors (ICI) in second-line non-small cell lung cancer in Thailand., and (2) evaluate the financial toxicity among lung cancer patients in Thailand. Materials and Methods: Economics evaluation using clinical input from published clinical trials data together with the cost and utility information from face-to-face questionnaire interviews. The incremental cost-effectiveness of ICI compared with docetaxel was computed using partition survival and the Markov model. Financial toxicity evaluation using data from the questionnaires in the cross-sectional design. Results: The ICI treatment improved survival by 0.55 to 0.81 life years. The incremental cost of ICI treatment ranged from USD 18,683 for atezolizumab to USD 69,723 for pembrolizumab. The ICI treatment improves QALY of about 0.43-0.62. The ICER for nivolumab, pembrolizumab, and atezolizumab were USD 84,957, USD 115,365, and USD 30,003, respectively. About 66% of the patients with lung cancer experience catastrophic health expenditure (CHE) and 29% of the patients develop medical impoverishment. Conclusion: The ICI treatment provided better survival and QALY but was more costly. Atezolizumab was the most favored regimen compared with the other two ICI. However, the ICER for atezolizumab was higher than Thailand's cost-effectiveness acceptability threshold of USD 5,208. A significant proportion of lung cancer patients in Thailand experienced financial toxicity.