Cost-Effectiveness Analysis of Immunotherapy in Non-Small Cell Lung Cancer

Immunotherapy has transformed the management of non-small cell lung cancer (NSCLC), offering durable responses and survival benefits compared with conventional chemotherapy. However, the high acquisition and administration costs of immune checkpoint inhibitors have prompted intensive evaluation of value. Cost-effectiveness analysis employs economic modelling—most commonly Markov cohort models or partitioned survival models—to estimate lifetime costs and outcomes in terms of quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) quantifies the additional expenditure per QALY gained, while willingness-to-pay thresholds reflect societal or payer benchmarks for value. Studies have assessed first-line monotherapy with anti–PD-1/PD-L1 agents, combinations with chemotherapy or dual checkpoint blockade, and perioperative or consolidation settings. Biomarker stratification, notably PD-L1 expression and tumour mutational burden, has been shown to enhance cost-effectiveness by targeting therapy to patients most likely to benefit. Across different health-care systems—from the United States and Europe to China—analyses reveal that price reductions, domestic drug development and rigorous patient selection are critical levers to improve the value proposition. Emerging evidence also highlights the influence of adverse-event management and long-term follow-up data on economic outcomes, underlining the need for dynamic models that adapt as clinical practice evolves.

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Cost-Effectiveness Analysis of Immunotherapy in Non-Small Cell Lung Cancer publication trend

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Technical terms

Quality-adjusted life-year (QALY): A composite measure that captures both the quantity and quality of life gained from a health-care intervention.

Incremental cost-effectiveness ratio (ICER): The additional cost required to gain one extra QALY when comparing two interventions.

Markov model: A mathematical framework that simulates transitions between defined health states over time to estimate long-term costs and outcomes.

Programmed death-ligand 1 (PD-L1) expression: A tumour biomarker used to predict responsiveness to PD-1/PD-L1 inhibitors and guide patient selection for immunotherapy.

Willingness-to-pay threshold: The maximum amount a health-care system or society is prepared to pay for each additional QALY gained.

References

1. Cost-effectiveness of neoadjuvant pembrolizumab plus chemotherapy with adjuvant pembrolizumab for early-stage non-small cell lung cancer in the United States. Frontiers in Immunology (2023).
2. Cost-effectiveness of tumor-treating fields plus standard therapy for advanced non-small cell lung cancer progressed after platinum-based therapy in the United States. Frontiers in Pharmacology (2024).
3. Cost-Effectiveness of Treatment Optimisation with Biomarkers for Immunotherapy in Solid Tumours: A Systematic Review. Cancers (2024).