Adjuvant Immunotherapy Costs Challenge Lung Cancer Affordability
Key Clinical Summary
- Adjuvant immunotherapies in lung cancer improved quality-adjusted life years, but per-patient costs often exceeded $200 000 to $300 000.
- Cost-effectiveness varied widely by drug, country, biomarker status, pricing, and willingness-to-pay threshold.
- Budget impact modeling showed accelerated uptake could create substantial short-term fiscal pressure for health systems.
Adjuvant immunotherapies have improved outcomes in lung cancer, but a new economic review suggests their affordability depends heavily on patient selection, pricing, and how quickly health systems adopt them. The analysis combined a systematic review of economic evaluations from 2010 to 2024 with a 5-year budget impact model.
Clinical Benefits and Cost-Effectiveness Trends
Investigators reviewed 35 published economic evaluations of adjuvant immunotherapies in lung cancer, including 33 studies in non–small cell lung cancer (NSCLC) and 2 in small cell lung cancer. Frequently evaluated agents included pembrolizumab, nivolumab, atezolizumab, and durvalumab, along with emerging therapies such as sintilimab, sugemalimab, camrelizumab, and icotinib.
Across studies, adjuvant immunotherapies generally improved health outcomes compared with chemotherapy or standard care. Several models reported incremental gains of approximately 0.3 to 0.5 quality-adjusted life years, while selected biomarker-defined or Chinese cohorts achieved gains of 1.0 quality-adjusted life year or more.
However, costs were substantially higher. Per-patient costs often exceeded $230 000 to $390 000 for programmed cell death protein 1/programmed death ligand 1–based regimens, and some middle-income settings reported costs more than 10-fold higher than standard care.
Incremental cost-effectiveness ratios varied widely. Some therapies, such as icotinib in China and selected pembrolizumab, sintilimab, sugemalimab, nivolumab, and sequencing strategies, were cost-effective within local thresholds. Other regimens exceeded $300 000 to $600 000 per quality-adjusted life year, particularly with broad, unselected use, combination therapy, or small cell lung cancer indications.
Budget Impact and Access Considerations
For managed care decision-makers, the findings underscore that cost-effectiveness does not automatically translate into affordability. Even therapies considered cost-effective at the patient level may impose substantial budget pressure when adopted broadly.
The 5-year budget impact analysis showed that high-cost regimens, particularly pembrolizumab- and durvalumab-based strategies, generated the largest cumulative spending. Accelerated uptake sharply increased early fiscal pressure, while restricted or phased uptake reduced cumulative 5-year budget impact by roughly one-third to nearly one-half, depending on the agent.
These findings support strategies such as biomarker-guided prescribing, managed entry agreements, phased reimbursement, outcomes-based contracting, and price negotiation. The authors also cautioned that broad adoption without access safeguards could worsen disparities, especially in lower-resource settings.
Balancing Value With Sustainable Adoption
Adjuvant immunotherapy may offer important clinical value in lung cancer, but sustainable scale-up will require careful alignment of pricing, reimbursement, biomarker selection, and uptake policies. For payers, budget impact analysis should complement cost-effectiveness evidence before broad adoption.
Reference
Mahumud AR, Chen Y, Dahal PK, Akter N, Shahjalal Md, Alam K. Economic value, affordability, and scale-up of adjuvant immunotherapies in lung cancer treatment: from cost-effectiveness decision to budget impact analysis. J Cancer Policy. 2026;47:100718. doi:10.1016/j.jcpo.2026.100718
