The Social Value of Immunotherapy in Non-Small Cell Lung Cancer

Cancer immunotherapies have demonstrated great efficacy in a wide range of patients, with some achieving extended disease control. We investigated the potential increases in social value that could be gained via widespread use of immunotherapy in treating non-small cell lung cancer (NSCLC). Using The Health Economics Medical Innovation Simulation (THEMIS) and clinical trial data, we modeled survival post-diagnosis for late-stage NSCLC patients under non-immunotherapy versus immunotherapy regimes. THEMIS tracks a representative sample of patients age 51+ over the next 50 years to project quality-adjusted life years (QALYs) and medical costs. We estimated these outcomes under a baseline non-immunotherapy scenario and compared them with two treatment scenarios where we varied the percent of immunotherapy patients who achieved extended disease control (receiving survival benefits and returning to pre-cancer quality of life). Half of all patients were assumed to receive significant survival benefits from treatment. We derived probability of disease, disability, mortality incidence, and medical costs from nationally representative datasets. Mortality and disease stage were estimated using the Surveillance, Epidemiology, and End Results database. Use of immunotherapies for late-stage NSCLC patients results in gains of 0.3 QALYs per treated patient and 1.5 QALYs per patient achieving extended disease control. The increase in QALYs would be valued at $605–$692 billion, assuming $200,000 value of statistical life year. If response to immunotherapy is unknown prior to treatment, we estimate a net social cost of $3.1 billion for treating all late-stage NSCLC patients. Immunotherapy for the treatment of NSCLC has high potential social value. However, the cost-benefit tradeoff depends highly on personalizing the treatment each patient receives based on their individual response to immunotherapy.