The DOI matches its Crossref record; 17 of the 17 references it cites were found in a registry or an index.
A systematic review of the cost and cost-effectiveness studies of immune checkpoint inhibitors
Open accessAbstract
BACKGROUND: Escalating healthcare costs are necessitating the practice of value-based oncology. It is crucial to critically evaluate the economic impact of influential but expensive therapies such as immune checkpoint inhibitors (ICIs). To date, no systematic assessment of the cost-effectiveness (CE) of ICIs has been performed. METHODS: PRISMA-guided systematic searches of the PubMed database were conducted. Studies of head/neck (n = 3), lung (n = 5), genitourinary (n = 4), and melanoma (n = 8) malignancies treated with ICIs were evaluated. The reference willingness-to-pay (WTP) threshold was $100,000/QALY. RESULTS: Nivolumab was not cost-effective over chemotherapy for recurrent/metastatic head/neck cancers (HNCs). For non-small cell lung cancer (NSCLC), nivolumab was not cost-effective for a general cohort, but increased PD-L1 cutoffs resulted in CE. Pembrolizumab was cost-effective for both previously treated and newly-diagnosed metastatic NSCLC. For genitourinary cancers (GUCs, renal cell and bladder cancers), nivolumab and pembrolizumab were not cost-effective options. Regarding metastatic/unresected melanoma, ipilimumab monotherapy is less cost-effective than nivolumab, nivolumab/ipilimumab, and pembrolizumab. The addition of ipilimumab to nivolumab monotherapy was not adequately cost-effective. Pembrolizumab or nivolumab monotherapy offered comparable CE profiles. CONCLUSIONS: With limited data and from the reference WTP, nivolumab was not cost-effective for HNCs. Pembrolizumab was cost-effective for NSCLC; although not the case for nivolumab, applying PD-L1 cutoffs resulted in adequate CE. Most data for nivolumab and pembrolizumab in GUCs did not point towards adequate CE. Contrary to ipilimumab, either nivolumab or pembrolizumab is cost-effective for melanoma. Despite these conclusions, it cannot be overstated that careful patient selection is critical for CE. Future publication of CE investigations and clinical trials (along with longer follow-up of existing data) could substantially alter conclusions from this analysis.
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Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement
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Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer
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Nivolumab versus Docetaxel in Advanced Squamous-Cell Non–Small-Cell Lung Cancer
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Combined Nivolumab and Ipilimumab or Monotherapy in Untreated Melanoma
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Pembrolizumab versus Ipilimumab in Advanced Melanoma
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Nivolumab versus Everolimus in Advanced Renal-Cell Carcinoma
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Nivolumab in Previously Untreated Melanoma without BRAF Mutation
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Overall Survival with Combined Nivolumab and Ipilimumab in Advanced Melanoma
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Nivolumab for Recurrent Squamous-Cell Carcinoma of the Head and Neck
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Cited by
Wang, X., Barrera, C., Bera, K., Viswanathan, V. S., Azarianpour-Esfahani, S., Koyuncu, C., Velu, P., Feldman, M. D., Yang, M., Fu, P., et al. (2022) · Science Advances · doi:10.1126/sciadv.abn3966 · Cited by 89
Lelliott, E. J., McArthur, G. A., Oliaro, J., & Sheppard, K. E. (2021) · Frontiers in Immunology · doi:10.3389/fimmu.2021.661737 · Cited by 65
Refining patient selection for breast cancer immunotherapy: beyond PD-L1
Kossai, M., Radosevic-Robin, N., & Penault-Llorca, F. (2021) · ESMO Open · doi:10.1016/j.esmoop.2021.100257 · Cited by 36
Yoshioka, T., Azuma, S., Funada, S., Itaya, T., & Goto, R. (2025) · Clinical Drug Investigation · doi:10.1007/s40261-025-01435-w · Cited by 2
Metadata
- Authors
- Verma, V., Sprave, T., Haque, W., Simone, C. B., Chang, J. Y., Welsh, J. W., & Thomas, C. R.
- Venue
- Journal for ImmunoTherapy of Cancer
- Publisher
- BMJ
- Published
- 2018-11-23
- Volume
- 6
- Issue
- 1
- Pages
- 128-128
- ISSN
- 2051-1426 (ISSN-L)
- OpenAlex
- W2901619788
- Cited by
- 319
- References
- 17
- FWCI
- 13.62
- Type
- journal article
- Language
- en
- Open access
- gold
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