Effect of Treatment with the PD-1/PD-L1 Inhibitors on Key Health Outcomes of Cancer Patients
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ORIGINAL RESEARCH ARTICLE
Effect of Treatment with the PD‑1/PD‑L1 Inhibitors on Key Health Outcomes of Cancer Patients Kyung‑In Joung1 · Jong Hwa Song1 · Kangho Suh2 · Seung‑Mi Lee3 · Ji Hyun Jun1 · Taehwan Park4 · Dong Churl Suh1 Accepted: 20 November 2020 © Springer Nature Switzerland AG 2020
Abstract Background Recent studies have shown that treatment with the programmed cell death protein 1 (PD-1)/programmed deathligand 1 (PD-L1) inhibitor class could significantly improve survival outcomes in several oncology indications. However, there is some clinical uncertainty. Objective This study aimed to obtain high-level estimates of the impact of treatment with PD-1/PD-L1 inhibitor class to oncology treatment on key health outcomes in real-world situations and to inform public health policy decisions about cancer care after reducing uncertainties around new immuno-oncology therapy options in South Korea. Methods A model was developed to estimate the impact of PD-1/PD-L1 inhibitors on outcomes in situations wherein both anti-PD‐1/PD‐L1s and standard of care (SOC) were available versus SOC only. A partitioned survival model was utilized to estimate the impact of introducing anti-PD‐1/PD‐L1s on outcomes, including life-years gained, quality-adjusted life-years gained, progression-free survival-years obtained, and grade 3 or higher adverse events avoided for six indications over 5 years. An exponential distribution was fitted to the survival function of the SOC based on visual inspection. Outcomes associated with anti-PD‐1/PD-L1s were estimated using a piecewise modeling approach with Kaplan–Meier analysis followed by best-fitting survival analysis. The incident number of patients and market share of anti–PD‐1/PD‐L1s during 2020–2024 were projected using published literature and Korean market survey data. Sensitivity analyses were performed to test the uncertainty of input parameters. Results During the next 5-year period (2020–2024), introducing the anti-PD‐1/PD-L1 class led to a gain of 22,001 life-years (+ 31%), 19,073 quality-adjusted life-years (+ 38%), and 22,893 progression-free survival-years (+ 82%); it also avoided 3610 adverse events (− 11%) compared with SOC alone. Most adverse events associated with anti-PD‐1/PD‐L1s were attributed to combination therapy with cytotoxic chemotherapy (91%). In a scenario wherein the time to reimbursement of the anti-PD‐1/PD‐L1s was accelerated by 1 year, the life-years gained increased by 14% compared with the base-case scenario. Conclusions Anti-PD‐1/PD‐L1 therapy is expected to provide marked survival benefits for patients with cancer. This study demonstrated the potentially beneficial health impacts of utilizing the anti-PD‐1/PD‐L1 class at the population level. The findings could inform health policy decision makers about cancer care and ultimately enhance population health through rapid access to innovative cancer drugs.
Kyung-In Joung and Jong Hwa Song contributed equally to this study and should be considered as co-first authors. Taehwan Park and Dong Churl Suh
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