Cost-Effectiveness of Treatment Optimisation with Biomarkers for Immunotherapy in Solid Tumours: A Systematic Review

Simple Summary Researchers aim to assess the economic impact of testing predictive biomarkers for immunotherapy in solid tumour treatment using immune checkpoint inhibitors (ICIs). Despite recent advancements, concerns persist regarding the cost-effectiveness and budgetary implications of ICIs. This study systematically reviewed the economic evaluations of biomarker testing from various databases. The team assessed studies from June 2010 to February 2022, evaluating their quality and synthesising findings by tumour type. Understanding the economic implications of these tests could help drive future research, optimise treatment strategies, potentially influencing health care decisions and resource allocation in solid tumour therapy, impacting how we approach and fund immunotherapy for better patient outcomes.Abstract 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.