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Systematic Review of Pharmacoeconomic Studies on Immuno-Oncology: Assessment of the cost-effectiveness of Immuno-oncology medicines used in the treatment of Advanced Melanoma
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Orientador(es)
Resumo(s)
A imunoterapia para o cancro mudou o paradigma de tratamento para todas as pessoas diagnosticadas com Melanoma Metastático. Estas imunoterapias quando comparadas com a quimioterapia, proporcionam aos doentes não só um aumento na sua esperança de vida mas também uma melhoria muito significativa na sua qualidade de vida. No entanto, esta nova abordagem acarreta um aumento nos custos relacionados com o tratamento e tem particularidades no que concerne à avaliação da sua eficácia clínica. Num ambiente definido pela escassez de recursos é crucial definir quais as formas mais eficazes de tratar as doenças. Por essa razão, os decisores devem suportar as suas decisões nos estudos económicos, porque ao considerarem todo o impacto económico causado por novos tratamentos podem assegurar a sustentabilidade dos sistemas de saúde. O objetivo deste estudo é rever, sistematizar e avaliar os estudos de custo-efetividade relevantes relacionados com o uso de imunoterapia para o tratamento do Melanoma Metastático produzidos desde 2013. Foi realizada um revisão sistemática da literatura para estudos de custo-efetividade e custo-utilidade de imunoterapias para o cancro. No total 480 estudos foram triados, desses estudos, 9 reuniam todos os critérios de inclusão. A avaliação da qualidade dos estudos incluídos foi realizada com recurso a uma ferramenta validada, “Quality of Health Economic Studies” ou QHES. Dois dos estudos incluídos avaliaram a relação de custo-efetividade do Pembrolizumab comparada com o Ipilimumab. Outros dois estudos avaliaram a relação de custo-efetividade do Nivolumab comparada com a do Ipilimumab. Dois estudos avaliaram a relação de custoefetividade de diferentes abordagem sequenciais no tratamento de doentes sem mutações BRAF. Dois estudos estudaram a relção de custo-efetividade de diferentes combinações terapêuticas. Um desses estudos avaliou a relação de custo-efetividade da combinação de Talimogene Laherparepvec com Ipilimumab em comparação com Ipilimumab em monoterapia. Outro estudo avaliou a relação de custo-efetividade da combinação de Nivolumab com Ipilimumab em comparação com Ipilimumab em monoterapia. Por fim, um estudo avaliou a relação de custo-efetividade de Vemurafenib seguido de Ipilimumab como segunda linha de tratamento em comparação com Vemurafenib em monoterapia. O questionário QHES revelou que seis dos noves estudos incluídos eram de alta qualidade e que os restantes três, apesar de terem uma qualidade aceitável, ficaram perto do limiar de alta qualidade.
Cancer immunotherapies have given new hopes to patients with Metastatic Melanoma by improving the overall survival and the quality of life of the patients when compared with conventional chemotherapy. However, these new therapies increase the costs of treatment and present new challenges regarding their clinical efficacy assessment. In an environment defined by the scarcity of resources, it is crucial to define the most effective ways of managing diseases. Therefore, decision-makers must support their decisions on economic analysis in order to consider the economic impact of new treatments and in this way, ensure the sustainability of health care systems. The purpose of this study is to review, systematize and assess the relevant costeffectiveness studies produced since 2013 regarding cancer immunotherapies for Metastatic Melanoma. A systematic literature review was conducted for cost-effectiveness and cost-utility, analysis of cancer immunotherapy drugs. A total of 480 studies were screened and, of those, nine studies met all the inclusion criteria. The quality of the included studies was evaluated with the Quality of Health Economic Studies (QHES) assessment tool. Two studies assessed the cost-effectiveness (CE) of Pembrolizumab against Ipilimumab. Another two studies analysed the CE of Nivolumab against Ipilimumab. Two studies assessed the cost-effectiveness of different sequential approaches for the treatment of BRAF wild-type patients. Two studies measured the CE of different combination strategies. One study compared the CE of the combination of Talimogene Laherparepvec and Ipilimumab against Ipilimumab monotherapy. Another one, analysed the cost-effectiveness of Nivolumab combined with Ipilimumab against Ipilimumab or Nivolumab monotherapy. Lastly, one study assessed the cost-effectiveness of Ipilimumab in the second-line of treatment following Vemurafenib against Vemurafenib alone. The QHES assessment tool revealed that the quality of six out of the nine studies included was high, and the other three despite being fair in quality, had their scores near the high-quality threshold.
Cancer immunotherapies have given new hopes to patients with Metastatic Melanoma by improving the overall survival and the quality of life of the patients when compared with conventional chemotherapy. However, these new therapies increase the costs of treatment and present new challenges regarding their clinical efficacy assessment. In an environment defined by the scarcity of resources, it is crucial to define the most effective ways of managing diseases. Therefore, decision-makers must support their decisions on economic analysis in order to consider the economic impact of new treatments and in this way, ensure the sustainability of health care systems. The purpose of this study is to review, systematize and assess the relevant costeffectiveness studies produced since 2013 regarding cancer immunotherapies for Metastatic Melanoma. A systematic literature review was conducted for cost-effectiveness and cost-utility, analysis of cancer immunotherapy drugs. A total of 480 studies were screened and, of those, nine studies met all the inclusion criteria. The quality of the included studies was evaluated with the Quality of Health Economic Studies (QHES) assessment tool. Two studies assessed the cost-effectiveness (CE) of Pembrolizumab against Ipilimumab. Another two studies analysed the CE of Nivolumab against Ipilimumab. Two studies assessed the cost-effectiveness of different sequential approaches for the treatment of BRAF wild-type patients. Two studies measured the CE of different combination strategies. One study compared the CE of the combination of Talimogene Laherparepvec and Ipilimumab against Ipilimumab monotherapy. Another one, analysed the cost-effectiveness of Nivolumab combined with Ipilimumab against Ipilimumab or Nivolumab monotherapy. Lastly, one study assessed the cost-effectiveness of Ipilimumab in the second-line of treatment following Vemurafenib against Vemurafenib alone. The QHES assessment tool revealed that the quality of six out of the nine studies included was high, and the other three despite being fair in quality, had their scores near the high-quality threshold.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, Universidade de Lisboa, Faculdade de Farmácia, 2019
Palavras-chave
Melanoma Revisão Sistemática Imunoterapia Cancro Custo-efetividade Mestrado Integrado - 2019