Cost-effectiveness analysis of nivolumab for the treatment of squamous cell carcinoma of the head and neck in the United States

Abstract

Aim: To assess the cost-effectiveness of nivolumab monotherapy for recurrent/metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN) in the US. Methods: We constructed a cohort-based partitioned survival model for three health states (progression-free, progressed disease, and death). Using overall survival and progression-free survival data from the nivolumab and investigator's choice (IC) arms of the CheckMate 141 study, the proportion of patients in each health state was estimated by parametric modeling over a 25-year period. Cost, utility, adverse event, and disease management data inputs were obtained from relevant literature and applied to patients in each health state. A scenario analysis was conducted assuming increased uptake of subsequent immunotherapies. A one-way deterministic sensitivity analysis assessed the impact of variation in multiple parameters. A probabilistic sensitivity analysis in which probabilistic distributions were applied to each input during 1,000 model iterations was also conducted.

Nivolumab vs Pembrolizumab for Treatment of US Patients With Platinum-Refractory Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma

“…The health utilities were sourced from an updated cost-effectiveness analysis generated by applying a US population preference-weighting algorithm to the EuroQol-5D 3-level health questionnaire data from the CheckMate 141 trial. 11 Health utilities for KEYNOTE 040 were unavailable; thus, we used those from CheckMate 141 given their similarities. The adverse events associated with utility decrements were obtained from the literature 11 , 24 , 25 , 26 , 27 , 28 , 29 , 30 (eTable 4 in the Supplement ).…”

“…Drug costs were derived from the 2020 mean sale price of the Centers for Medicare & Medicaid Services ( Table 1 ). 6 , 7 , 11 , 19 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 Given the amount of leftover nivolumab resulting from the weight-based administration, a rate of 6.1% for the real-world wastage of nivolumab was considered. 42 We acquired the costs of administration, immunohistochemical tests, and follow-up from the 2020 Medicare physician fee schedule and Medicare fee-for-service payment.…”

“… 35 , 36 The management costs associated with adverse events were sourced from the literature. 11 , 19 , 37 , 38 , 39 , 40 , 41 All costs were inflated to 2020 US dollars using the Consumer Price Index. 44…”

A novel comprehensive immune-related gene signature as a promising survival predictor for the patients with head and neck squamous cell carcinoma

“…With the emergence of checkpoint immunosuppressive therapy, the treatment regimens have completely changed for many advanced malignant tumors including HNSCC. However, the checkpoint blockade immune therapeutics does not respond to all patients and the observed objective response rates are in the range of only 16% to 25% [ 15 , 16 ]. Therefore, an immune-related prognostic signature which can not only predicts survival, but predicts the immunotherapy response for different groups of patients is urgently need.…”

A novel comprehensive immune-related gene signature as a promising survival predictor for head and neck squamous cell carcinoma

“…As a result of intense study of the tumor immune-related mechanism, the emergence of checkpoint immunosuppressive therapy has completely changed treatment regimens for many advanced malignant tumors including HNSCC. Checkpoint blockade immunotherapeutics, such as nivolumab and pembrolizumab, are primarily used in the patients with recurrent or metastatic disease, but the observed objective response rates are in the range of only 16-25% [12,13]. Increasing evidence has also revealed that a prognostic signature containing several to dozens of genes have laid a foundation for predicting the survival of HNSCC [14][15][16].…”