| Titre : | Immuno-oncology (IO) Rechallenge Approach and Its Impact on The Cost-Effectiveness of IO in Early-Stage Cancer |
| Auteurs : | Maulidia Ekaputri ; Ecole des hautes études en santé publique (EHESP) (Rennes, FRA) |
| Type de document : | Mémoire |
| Année de publication : | 2024 |
| Description : | 58p. / fig., tabl. |
| Langues: | Anglais |
| Classement : | MPH/ (Mémoires MPH à partir de 2024) |
| Mots-clés : | Cancérologie ; Immunologie ; Analyse coût efficacité ; Revue de littérature ; Traitement ; Cancer ; Immunothérapie |
| Résumé : |
Introduction: Immuno-oncology (IO) rechallenges in the metastatic setting, after usage in earlier stages, is challenging. The lack of rationale of IO rechallenge approaches complicates the development of pharmacoeconomic models. This study aims to review the different assumptions of IO rechallenge used in health technology assessment (HTA) submissions for early-stage cancer, and test their impact on the cost-effectiveness result.
Methods: This study consisted of two steps. First, a literature review on HTA submissions for IO in early-stage cancer was performed. The HTAs were assessed for the IO rechallenge approach and related criticisms. Then, a cost-effectiveness model was to test different IO rechallenge scenarios. The model was built to reflect NICE TA851. The input parameters were obtained from KEYNOTE-522 and KEYNOTE-355 trials, relevant HTAs, and data for the UK population. The IO rechallenge was applied first in the distant metastatic state (DM) and then in both locoregional recurrence (LR) state and DM state. The resulting incremental cost-to-effectiveness ratios (ICER) were compared. The analysis was performed using R and Excel. Result: The literature review found that mostly IO rechallenge was permitted either in the DM and/or the LR state, under variable assumptions. Many of them assumed a minimum time interval between IO retreatment and previous treatment (6, 12, 18, or 24 months). Although the models were generally accepted, many criticisms arose, especially regarding the uncertainty of IO restriction and the lack of real-world evidence. Then, the cost-effectiveness model found that different IO restriction scenarios in the DM state only slightly altered the ICER (0-2.4%) but produced more prominent changes if applied in both DM and LR states (21.8-45.8%). Conclusion: This study indicates that different IO rechallenge approaches could change the ICER significantly, and its impact could be augmented if applied in multiple post-progression states. Studies are needed to suggest the optimal IO rechallenge approach. |
| Diplôme : | Master MPH of public health |
| Plan de classement simplifié : | Master of Public Health - master international de Santé Publique (MPH) |
| En ligne : | https://documentation.ehesp.fr/memoires/2024/mph/maulidia_ekaputri.pdf |
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