This study investigated the health economic evaluations of predictive biomarker testing in solid tumours treated with immune checkpoint inhibitors (ICIs). Searching PubMed, EMBASE, and Web of Science from June 2010 to February 2022, 58 relevant articles were reviewed out of the 730 screened. The focus was predominantly on non-small cell lung cancer (NSCLC) (65%) and other solid tumours (40%). Among the NSCLC studies, 21 out of 35 demonstrated cost-effectiveness, notably for pembrolizumab as first-line treatment when preceded by PD-L1 assessment, cost-effective at a threshold of $100,000/QALY compared to the standard of care. However, for bladder, cervical, and triple-negative breast cancers (TNBCs), no economic evaluations met the affordability threshold of $100,000/QALY. Overall, the review highlights a certain degree of uncertainty about the cost-effectiveness of ICI. In particular, we found PD-L1 expression associated with ICI treatment to be a cost-effective strategy, particularly in NSCLC, urothelial, and renal cell carcinoma. The findings suggest the potential value of predictive biomarker testing, specifically with pembrolizumab in NSCLC, while indicating challenges in achieving cost-effectiveness for certain other solid tumours.
本研究探讨了在采用免疫检查点抑制剂（ICI）治疗的实体瘤中进行预测性生物标志物检测的卫生经济学评价。通过检索2010年6月至2022年2月期间PubMed、EMBASE和Web of Science数据库，从730篇筛选文献中最终纳入58篇相关文章进行分析。研究主要聚焦于非小细胞肺癌（占65%）及其他实体瘤（占40%）。在非小细胞肺癌相关研究中，35项中有21项证明具有成本效益，其中尤为突出的是：在PD-L1检测基础上使用帕博利珠单抗作为一线治疗方案，与标准治疗相比，在10万美元/质量调整生命年阈值下具有成本效益。然而，对于膀胱癌、宫颈癌及三阴性乳腺癌，尚无经济学评价达到10万美元/质量调整生命年的可负担性阈值。总体而言，本综述揭示了ICI成本效益存在一定程度的不确定性。特别值得注意的是，我们发现将PD-L1表达检测与ICI治疗相结合是具有成本效益的策略，尤其在非小细胞肺癌、尿路上皮癌和肾细胞癌中表现显著。研究结果表明预测性生物标志物检测具有潜在价值，特别是在非小细胞肺癌中使用帕博利珠单抗的案例中，同时也揭示了在某些其他实体瘤中实现成本效益仍面临挑战。
肿瘤(癌症)患者之家