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Table 1 Details regarding cost-effectiveness studies of head and neck cancers

From: A systematic review of the cost and cost-effectiveness studies of immune checkpoint inhibitors

Reference, Country, Year Comparison Methodologya Costs QALYs ICER WTP Conclusions Criticisms
Ward et al., USA, 2017 [25] Nivo vs. standard (choice of cetux, doc, or MTX) for recurrent/metastatic HNC Markov; PD-L1 cutoff ≥1%; accounted for toxicity, administration, end-of-life costs $73,463 nivo, $26,133 standard 0.626 nivo, 0.289 standard Relative to standard, nivo $140,672/QALY; nivo with PD-L1 testing $131,066/QALY; relative to cetux, nivo $89,786/QALY; relative to MTX, nivo $154,411/QALY; relative to doc, nivo $154,191/QALY $100,000/QALY Nivo not CE in this setting; PD-L1 testing minimally influences results - Although per prospective data, heterogeneity of “standard” cohort using several different agents difficult to interpret, and not necessarily representative of practice patterns
- Disutility scores based on weaker, non-prospective data
- Lack of accountability for grade < 3 toxicities or p16 disease
Zargar et al., Canada, 2018 [26] Nivo vs. doc for recurrent/metastatic HNC Markov; accounted for PD-L1, toxicity, and end-of-life costs CAD 60,035 ($46,563) nivo, CAD 41,212 ($31,964) doc 0.248 nivo, 0.130 doc Relative to doc, nivo CAD 144,744 ($112,263)/QALY CAD 100,000 ($78,385)/QALY Although numerically more favorable in younger, p16+, PD-L1 > 5% patients, nivo not CE - Although prospective trial data used, that trial did not utilize single-agent docetaxel as in this study, but rather a combination of three agents
- Did not account for administration costs
- Only grade ≥ 3 toxicities accounted for, as a one-time cost
Tringale et al., USA, 2018 [27] Nivo vs. standard (choice of cetux, doc, or MTX) for recurrent/metastatic HNC Markov; accounted for toxicity, administration, societal, and end-of-life costs $174,800 nivo, $57,000 standard 0.796 nivo, 0.396 standard Relative to standard, nivo $294,400/QALY; relative to cetux, nivo $182,200/QALY $100,000/QALY Nivo not CE in this setting - Overall modeling horizon of 30 years, when exceedingly low numbers of patients still alive, causing errors in survival extrapolation and thus costs
- Only grade ≥ 3 toxicities accounted for, as a one-time cost
- Did not consider PD-L1 status or p16 disease
  1. QALY quality-adjusted life year, ICER incremental cost-effectiveness ratio, WTP willingness to pay (threshold); nivo, nivolumab; cetux, cetuximab; doc, docetaxel, MTX methotrexate, HNC head and neck cancers, CE cost-effective, PD-L1 programmed cell death ligand-1, CAD Canadian dollar
  2. aAll studies consisted of three basic health states (progression-free (stable), progressive disease, and death); all studies performed sensitivity analyses in addition to the base case