'Faculty of Medicine Prince of Songkla University'
Abstract
Doctor of Philosophy (Health Sciences), 2023Introduction: Lung cancer is the most common cancer in males and the fourth most common
in females. Although there are many novel effective treatments available on the market, patients
are mainly unable to access them. The biggest barrier factor is the cost of treatment which may
cause financial toxicity to the patients, family, or even to the healthcare system, especially in low
or middle-income countries. This study aims to (1) evaluate the cost-effectiveness of applying
immune checkpoint inhibitors (ICI) in second-line non-small cell lung cancer in Thailand., and
(2) evaluate the financial toxicity among lung cancer patients in Thailand.
Materials and Methods: Economics evaluation using clinical input from published clinical trials data
together with the cost and utility information from face-to-face questionnaire interviews. The
incremental cost-effectiveness of ICI compared with docetaxel was computed using partition
survival and the Markov model. Financial toxicity evaluation using data from the questionnaires
in the cross-sectional design. Results: The ICI treatment improved survival by 0.55 to 0.81 life years. The incremental cost of ICI treatment ranged from USD 18,683 for atezolizumab to USD 69,723 for
pembrolizumab. The ICI treatment improves QALY of about 0.43-0.62. The ICER for
nivolumab, pembrolizumab, and atezolizumab were USD 84,957, USD 115,365, and USD
30,003, respectively. About 66% of the patients with lung cancer experience catastrophic health
expenditure (CHE) and 29% of the patients develop medical impoverishment.
Conclusion: The ICI treatment provided better survival and QALY but was more costly.
Atezolizumab was the most favored regimen compared with the other two ICI. However, the
ICER for atezolizumab was higher than Thailand's cost-effectiveness acceptability threshold of
USD 5,208. A significant proportion of lung cancer patients in Thailand experienced financial toxicity