Cost-effectiveness of PD-L1 testing to guide immunotherapy for patients with advanced non-small-cell lung cancer in China

Aim: This study aims to assess the cost-effectiveness of three major programmed death-ligand 1 (PD-L1) immunohistochemistry (IHC) testing assays in guiding immunotherapy for patients with advanced non-small-cell lung cancer (NSCLC) in China, and to provide empirical evidence on the selection of cost-effective diagnostics to support the immune checkpoint inhibitor monotherapy regimens for NSCLC patients. Materials & methods: From a healthcare system perspective, a decision tree model was constructed to simulate the cost and effectiveness of employing VENTANA PD-L1 (SP263) Assay, Dako PD-L1 IHC 22C3 assay, and Dako 22C3 antibody concentrate in advanced NSCLC patients in China. The cost-effectiveness of Ventana PD-L1 IHC SP263 assay compared with other testing methods was assessed through the incremental analysis. The robustness of the base case analysis results was validated by one-way sensitivity analysis and probabilistic sensitivity analysis. Results: The VENTANA PD-L1 (SP263) Assay, which can guide multiple immune checkpoint inhibitor monotherapies (e.g., atezolizumab and pembrolizumab) for advanced NSCLC patients, achieved a higher percentage of successfully diagnosed and treated, and a higher quality-adjusted life-year at a lower cost compared with Dako PD-L1 IHC 22C3 assay and Dako 22C3 antibody concentrate. The robustness of the base case results was confirmed by both one-way sensitivity analysis and probabilistic sensitivity analysis. Conclusion: The VENTANA PD-L1 (SP263) Assay is cost-effective compared with Dako PD-L1 IHC 22C3 assay and Dako 22C3 antibody concentrate for the immunotherapy treatment for advanced NSCLC patients in China.