P06: A Systematic Review of Health Utility Values for Immunotherapy-Related Adverse Events
Senior Manager, Oncology Epidemiology
Bristol-Myers Squibb Company United States
Health utility values (HUVs) are important in assessing the benefits and risks of cancer immunotherapies. Currently there is no consensus regarding HUVs for immune-related adverse events (irAEs). The objective of this systematic review was to summarize irAE HUVs from the published literature.
A structured electronic search for irAE-associated HUV studies published up to June 2020 was conducted using Embase. A stepwise literature selection with study title, abstract, and full text review was applied. Only peer-reviewed journal articles in English were eligible for this review.
The initial literature search resulted in the selection of 737 studies. After excluding 638 studies that were irrelevant to HUVs, 21 studies that had no full text available, and 54 studies that did not explore HUVs for irAEs, a total of 24 studies remained that met the inclusion criteria. These 24 studies were published between 2013 and 2020 with data from North America, Europe, and Asia. In these studies, the main treatment indications included melanoma or other skin cancer (8 studies, 33.33%), non-small cell lung cancer (6 studies, 25%), and renal cell carcinoma (5 studies, 20.83%). Most (17, 70.83%) studies collected irAE-related HUVs from the published literature, and 7 studies (29.17%) calculated utilities based on patient-reported outcomes from clinical trials. The immunotherapy medications used in these studies were nivolumab, ipilimumab, pembrolizumab, and atezolizumab, as either monotherapy or combined therapies with other medications. The disutilities of irAEs from health utilities ranged between -0.5 and -0.0002, with various types of AEs and grades. The most reported irAEs in these included studies were common adverse events (AEs) in immunotherapy, including nausea (HUVs range, -0.212 to -0.0017), pneumonitis/pneumonia (-0.2 to -0.09), fatigue (-0.17 to -0.0061), diarrhea (-0.32 to -0.0039), colitis (-0.207 to -0.13), rash (-0.13 to -0.0073), hepatitis or hepatic disorder (-0.17 to -0.114), and anemia (-0.25 to -0.0057).
Immunotherapy offers cancer patients the benefits of improved survival but may cause irAEs. As an additional parameter for assessing the benefits and risks of immunotherapy, irAE-related parameters such as the HUVs may be considered within the evaluation models. The combination of these values can provide an overall indication of the value of a treatment to the patient. To our knowledge, this is the first systematic summary of the existing literature that quantifies the HUVs for irAEs. This summary of findings from the published literature provides useful information about HUVs for irAEs. The utility value of one certain type of irAE varies depending on the severity of the AE, the cancer population, and the measurements. These values may be helpful in creating benefit-risk profiles of cancer immunotherapies. More information related to HUVs for other types of irAEs is needed.