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 |