Cost-Effectiveness of Nivolumab Plus Ipilimumab as First-Line Therapy in Advanced Non–small-cell Lung Cancer

Abstract

Purpose: The effectiveness of nivolumab plus ipilimumab for advanced non-small cell lung cancer (NSCLC) has been demonstrated. Decisions have to be made about allocating healthcare resources. Economic evidence could support policy decisions to fund expensive interventions. The current analysis evaluated the cost-effectiveness of nivolumab plus ipilimumab in advanced NSCLC harboring no EGFR or ALK mutations. It is set in the context of the US and China, representing developed and resource-constrained settings, respectively.Patients and Methods: A Markov model consisting of three discrete health states was used to assess the cost-effectiveness of nivolumab plus ipilimumab vs. chemotherapy. The key clinical data were derived from the CheckMate-227 trial, and the cost and health preference data were derived from the literature. Costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs) and incremental net health benefits (INHBs) were calculated for the two strategies. Subgroup, one-way and probabilistic sensitivity analyses were performed.Results: In the United States, nivolumab plus ipilimumab increased by 1.260 QALYs with an additional cost of $95,617 compared with the features of chemotherapy, which led to an ICER of $75,871 per QALY gained. INHB indicated that nivolumab plus ipilimumab treatment had a 99% probability of being cost-effective at the ICER threshold of $100,000/QALY in all subgroups. The results of sensitivity analyses revealed that the model outcomes were robust. In China, the ICER of nivolumab plus ipilimumab vs. chemotherapy was $59,773/QALY, and the INHB was -1.972 QALY at the threshold of $27,351/QALY.Conclusion: Nivolumab plus ipilimumab treatment is a cost-effective option compared with chemotherapy for patients with advanced NSCLC harboring no EGFR or ALK mutations in the United States. However, nivolumab plus ipilimumab is not a preferred option in China.

Cost-effectiveness of first line nivolumab-ipilimumab combination therapy for advanced non-small cell lung cancer: A systematic review and methodological quality assessment

“…In this study (18), the authors indicated that the vial prices of nivolumabipilimumab were discounted by 17%, based on a previously published study (26), and the cost of chemotherapy was $24,437 per patient regardless of histology (27). In the same study (18), the cost of maintenance chemotherapy was $5,887 for nonsquamous NSCLC (27). All remaining sources for drug prices were obtained from the US Medicare and Medicaid Services (25), literature, and publicly available sources (28).…”

“…Variable model cycle lengths were adapted, including intervals of one week (18), 3 weeks (21), 6 weeks (19,20,22,23), and one month (17). Similarly, time horizons varied among the CEAs, including 10 years (17,18,20), 20 years (19), and lifetime (21)(22)(23).…”

“…In one study (19), the authors did not specify a year for the included costs. In another study (18), the rationale for the cost year of 2018 was not included. In this study (18), the authors indicated that the vial prices of nivolumabipilimumab were discounted by 17%, based on a previously published study (26), and the cost of chemotherapy was $24,437 per patient regardless of histology (27).…”

“…In another study (18), the rationale for the cost year of 2018 was not included. In this study (18), the authors indicated that the vial prices of nivolumabipilimumab were discounted by 17%, based on a previously published study (26), and the cost of chemotherapy was $24,437 per patient regardless of histology (27). In the same study (18), the cost of maintenance chemotherapy was $5,887 for nonsquamous NSCLC (27).…”

“…Health state utility estimates were based on the literature (30)(31)(32)(33), for six CEAs (17,18,(20)(21)(22)(23). In one study (19), treatmentspecific utilities (0.784 combination therapy and 0.693 chemotherapy) were collected in the CheckMate 227 trial (34).…”