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Immunotherapies can substantially improve treatment efficacy, despite their high cost. A comprehensive overview of the cost-effectiveness analysis (CEA) of immune checkpoint inhibitors (ICIs) in patients with non-small cell lung cancer based on different tumor proportion scores (TPSs) was conducted. PubMed, Embase, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, and NHS Economic Evaluation databases were searched from their inception until August 24, 2022. Data relevant to the CEA results were recorded, and quality assessments conducted based on the Quality of Health Economic Studies (QHES) process. Fifty-one original studies from seven countries were included. The mean QHES score was 77.0 (range: 53–95). Twenty-seven studies were classified as high-quality, and the rest as fair quality. Pembrolizumab, nivolumab, ipilimumab, atezolizumab, camrelizumab, cemiplimab, sintilimab, tislelizumab, and durvalumab were identified using three TPS categories. While nivolumab plus ipilimumab and pembrolizumab plus chemotherapy were unlikely to be cost-effective in China, the results for the US were uncertain. Atezolizumab combinations were not cost-effective in China or the US, and tislelizumab and sintilimab were cost-effective in China. For TPSs ≥ 50%, the pembrolizumab monotherapy could be cost-effective in some developed countries. Cemiplimab was more cost-effective than chemotherapy, pembrolizumab, and atezolizumab in the US. For TPSs ≥ 1%, the cost-effectiveness of pembrolizumab was controversial due to the different willingness-to-pay thresholds. None of the atezolizumab combination regimens were found to be cost-effective in any perspective of evaluations. Camrelizumab, tislelizumab, and sintilimab have lower ICERs compared to atezolizumab, pembrolizumab, and nivolumab in China. Cemiplimab may be a more affordable alternative to pembrolizumab or atezolizumab. However, it remains unclear which ICIs are the best choices for each country. Future CEAs are required to select comprehensive regimens alongside randomized trials and real-world studies to help verify the economics of ICIs in specific decision-making settings. [Display omitted] • A total of 51 studies related to nine ICIs, and 21 patient regimes were included. • None of the atezolizumab combination regimens were found to be cost-effective. • Camrelizumab/tislelizumab/sintilimab had lower ICERs than atezolizumab/pembrolizumab/nivolumab in China. • Cemiplimab may be a cheaper alternative to pembrolizumab or atezolizumab. • Country/PD-L1 levels dictate several immune checkpoint inhibitor cost-effectiveness. [ABSTRACT FROM AUTHOR]

To evaluate the cost-effectiveness of pembrolizumab versus chemotherapy as the first-line treatment for metastatic non-small cell lung cancer (NSCLC) with different tumor proportion scores (TPS), from perspective of payers in China. Conclusions Compared to standard chemotherapy, pembrolizumab is not a cost-effective choice for patients with locally advanced or metastatic NSCLC from the perspective of Chinese payer, regardless of TPS. [Extracted from the article]

The aim of this study was to research whether there was expression of PD-L1 in plasma exosome of NSCLC patients and whether its expression can partly represent PD-L1 expression of corresponding lung tumor tissues. Plasma was collected before and after surgery of NSCLC patients with stage II to stage III. Plasma of NSCLC patients with stage IV was also collected before and after anti-PD-1/PD-L1 therapy. Digital PCR was used to detect PD-L1 and β-actin mRNA expression of plasma exosomes. Expression of PD-L1 in tumor tissues was determined by immunohistochemical staining (22C3). Pearson correlation analysis and wilcoxon rank sum test was performed by SPSS 22.0. A total of 126 patients (54 patients with surgery and 72 patients with non-surgery therapy) were participated in this study. Exosomal PD-L1 expression can be detected in all plasma samples. Exosomal expression of PD-L1 calculated by both absolute quantification method and relative quantification method showed a positive correlation with PD-L1 expression of tumor tissues (absolute quantification method: r2=0.289, P = 0.001; relative quantification method: r2=0.547, P = 0.000). However, expression of exosomal PD-L1 calculated by relative quantification calculation showed higher correlation. Exosomal PD-L1 expression significantly decreased after surgery (P < 0.001) and three patients who showed good response (PR) to anti-PD-1/PD-L1 therapy also showed significantly decreasing exosomal PD-L1 expression after anti-PD-1/PD-L1 therapy (P < 0.001). Plasma exosomes of NSCLC patients contains substantial expression of PD-L1. Plasma exosomal PD-L1 expression showed high correlation with PD-L1 expression of tumor tissues. Exosomal PD-L1 expression could represent PD-L1 expression of tumor tissues and might be a potential predictive marker for anti-PD-1/PD-L1 therapy. Jifeng Feng. The National Natural Science Foundation of China. All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]