A Cost-Effectiveness Analysis of Nivolumab versus Docetaxel for Advanced Nonsquamous NSCLC Including PD-L1 Testing
Correspondence information about the author PhD Klazien Matter-Walstra
Email the author PhD Klazien Matter-Walstra
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Figure 1
Model structure. PD-L1, programmed death ligand 1; C, chance node; M, Markov node.
Figure 2
Probabilistic sensitivity analyses for nivolumab (NIV) versus docetaxel (DOC) and by programmed death ligand 1 (PD-L1) testing with a cutoff of 1% or more positive cells (PD-L1 ≥1%). PD-L1 ≥1% testing versus docetaxel (patients with positive test results receive nivolumab, patients with negative test results receive docetaxel) and PD-L1 ≥1% test versus nivolumab. QALY, quality-adjusted life-year; WTP, willingness-to-pay threshold.
Figure 3
Tornado plot of the univariate sensitivity analyses for nivolumab (NIV) versus docetaxel (DOC). ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year; PFS, progression-free survival; OS, overall survival; FU, follow-up phase; FN, febrile neutropenia.
Figure 4
Results of the nivolumab (NIV) cost reduction analyses. DOC, docetaxel; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life years; WTP, willingness-to-pay threshold.
Abstract
Introduction
Nivolumab (NIV) was recently approved in several countries for patients with pretreated advanced NSCLC. NIV is not cost-effective compared with docetaxel (DOC) for the treatment of squamous NSCLC. However, its cost-effectiveness for nonsquamous NSCLC and the consequences of programmed death ligand 1 (PD-L1) testing are unknown.
Methods
This literature-based health economic study used CheckMate-057 trial data to model the incremental cost-effectiveness ratio (ICER) of NIV versus DOC in the Swiss health care setting. The effect of PD-L1 positivity for patient selection was assessed.
Results
In the base case model, NIV (mean cost CHF66,208; mean effect 0.69 quality-adjusted life-years [QALYs]) compared with DOC (mean cost CHF37,618; mean effect 0.53 QALYs) resulted in an ICER of CHF177,478/QALY gained. Treating only patients with PD-L1–positive tumors (threshold ≥10%) with NIV compared with treating all patients with DOC produced a base case ICER of CHF124,891/QALY gained. Reduced drug price, dose, or treatment duration decreased the ICER partly below a willingness-to-pay threshold of CHF100,000/QALY. Health state utilities strongly influenced cost-effectiveness.
Conclusions
Compared with DOC, NIV is not cost-effective for the treatment of nonsquamous NSCLC at current prices in the Swiss health care setting. Price reduction or PD-L1 testing and selection of patients for NIV on the basis of test positivity improves cost-effectiveness compared with DOC.
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Disclosure: Dr. Schwenkglenks reports grants from Amgen, the German Breast Group GBG, and Immunocore outside the submitted work. Dr. von Moos is a participant in a Bristol-Myers Squibb advisory board. The remaining authors declare no conflict of interest.
