Pcn145 Cost-Effectiveness Analysis of Durvalumab in Adult Patients With Locally Advanced Unresectable Non-Small Cell Lung Cancer After Concurrent Platinum-Based Chemoradiation in France

Abstract

The objective of this study was to evaluate the cost-effectiveness of nivolumab in combination with ipilimumab (Nivo+Ipi) compared to current therapeutic alternatives in first-line treatment of patients with advanced melanoma regardless of biomarker status in Belgium from a healthcare payer perspective using 48-month survival data from the CheckMate 067 Phase III trial. Methods: A threestate partitioned survival model was developed from projections of overall survival and progression free survival based on a network meta-analysis which considers time-varying hazard ratios to estimate accrued quality-adjusted survival and costs over a 30-year time horizon. The analysis considered nivolumab monotherapy as the key comparator but also included ipilimumab, pembrolizumab, dabrafenib, dabrafenib + trametinib, vemurafenib + cobimetinib, and dacarbazine. Drug acquisition, administration, follow-up, subsequent therapy and adverse event costs were obtained via published sources and expert input. Adverse event frequencies were collected from the Checkmate 067 trial and published literature. Utility weights were estimated from the Checkmate 067 trial, based on Belgian tariffs. A 3% discount rate was applied to costs and 1.5% rate to utilities. Results were presented as incremental cost-utility ratios (ICURs). BRAF status specific patterns of subsequent treatment were assigned. Results: Nivo+Ipi was projected to have the greatest accrued survival among the competing treatments with 8.8 LYs and 6.2 QALYs. The comparisons vs. nivolumab resulted in an ICUR of approximately V22,000 per QALY. Pairwise ICURs for Nivo+Ipi vs. other treatments ranged from V25,000 per QALY (vs. ipilimumab) to V38,000 per QALY (vs. dacarbazine). Conclusions: The analysis highlighted that Nivo+Ipi is associated with the highest gain in quality-adjusted survival accompanied by higher costs compared to the current therapeutic alternatives. ICUR results indicated that Nivo+Ipi is a cost-effective option in the first-line treatment of advanced melanoma in Belgium.