Cost-effectiveness of nivolumab plus ipilimumab as first-line treatment for American patients with unresectable malignant pleural mesothelioma

Abstract

BackgroundThe treatment paradigm of unresectable malignant pleural mesothelioma (MPM) has changed in recent years. Checkmate 743 demonstrate that nivolumab plus ipilimumab showed good clinical benefits compared with chemotherapy in the treatment of MPM. The study is aim to evaluate the cost-effectiveness of Nivolumab plus ipilimumab vs. platinum plus chemotherapy for the first-line treatment of unresectable MPM.MethodsA Markov model was developed to compare the cost and quality-adjusted life-year (QALY) of nivolumab plus ipilimumab and chemotherapy over a 10-year time horizon. Clinical efficacy and safety data were extracted from the CheckMate 743 trials. Health state utilities were obtained from published literature. Costs were collected from an US payer perspective. One-way and probabilistic sensitivity analyses were conducted to explore the impact of uncertainties on the cost-effectiveness's results.ResultsIn the base case analysis, the incremental healthcare costs and QALYs for Nivolumab plus Ipilimumab vs. chemotherapy are $196,604.22 and 0.53, respectively, resulting an incremental cost-effectiveness ratio (ICER) of $372,414.28/QALYs for the model cohort of patients with locally advanced or metastatic MPM. However, Probabilistic sensitivity analysis showed that there was no probability that Nivolumab plus ipilimumab was cost-effective within the fluctuation range of other model parameters in first-line in unresectable MPM. The results of one-way sensitivity analysis showed that the cost of Nivolumab was the most sensitive parameter.ConclusionsThe ICER of Nivolumab plus ipilimumab is above the theoretical willingness-to-pay threshold in the U.S, which suggests that first-line nivolumab plus ipilimumab for unresectable MPM may be not a cost-effective choice.

Immune Checkpoint Inhibitors in Malignant Pleural Mesothelioma: A Systematic Review and Meta-Analysis

“…A “financial toxicity” should also be taken into account, particularly for ICI combinations. Cost-effective analysis on output metrics including the patient’s lifetime quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratio (ICER) in United States (US) patients suggest that the combination of nivolumab and ipilimumab may not be a cost-effective choice as an up-front treatment [ 45 , 46 ]. Although the early use of ICIs in the first-line treatment has proved beneficial in other cancers, it is not possible to conclude that this will be the case in all patients with PM.…”

Pleural mesothelioma (PMe): The evolving molecular knowledge of a rare and aggressive cancer

“…This is now a standard treatment for PMe in the USA, Australia, and the UK. The approval has nonetheless raised criticisms by several experts who have questioned the clinical and pharmaeconomic benefit of this approach compared to standard chemotherapy, following a thorough analysis [ 145 , 146 , 147 , 148 , 149 ]. There are also a few other experimental approaches that are currently being explored for the treatment of this pathology.…”

True Benefits of Immune Checkpoint Inhibitors in the Treatment of Malignant Pleural Mesothelioma in Japan

“…Another study suggested that the incremental cost-effectiveness ratio of nivolumab plus ipilimumab as a first-line treatment for unresectable MPM exceeds the theoretical willingness-to-pay threshold in the United States, suggesting that nivolumab plus ipilimumab may not be a cost-effective option [25].…”

“…Therefore, Ye et al suggested that changing the price of nivolumab and ipilimumab is a valid and viable strategy for the efficient use of nivolumab and ipilimumab, and health insurance authorities should negotiate with pharmaceutical companies to ensure fair drug prices and adjust health insurance lists to reduce the burden of patient care [25].…”