Pcn227 a Partitioned Survival Model to Determine Cost-Effectiveness of Third-Line Nivolumab Monotherapy for Small Cell Lung Cancer

Abstract

Objectives: To evaluate the cost-effectiveness of treating relapsed/refractory multiple myeloma (RRMM) with carfilzomib, lenalidomide plus dexamethasone (KRd) compared to lenalidomide plus dexamethasone (Rd) and with carfilzomib plus dexamethasone (Kd) versus bortezomib plus dexamethasone (Vd) from a Colombian third-party payer perspective. Methods: An economic model was developed to estimate the treatment acquisition costs relative to treatment outcomes for KRd versus Rd and Kd versus Vd in the treatment of RRMM. Efficacy data were based on the ASPIRE and ENDEAVOR head-to-head pivotal trials comparing the therapies of interest. Only treatment acquisition costs were considered and were obtained from local price databases and expressed in local currency. Results were expressed as incremental cost per incremental month of duration of response (DOR), progression free survival (PFS) and overall survival respectively. A threshold of 3 times GDP per capita (63M COP) was considered to assess the comparative cost-effectiveness of each intervention. A scenario considering no drug wastage was also explored. Results: Both combinations with carfilzomib (KRd and Kd) were cost-effective (,3 times GDP per capita) compared to Rd and Vd respectively. For Kd versus Vd, ICERs ranged between 37.19M COP and 53.33M COP, with median DOR being the scenario with the lowest ICER, followed by median PFS. For KRd versus Rd, median PFS provided the most cost-effective scenario followed by median OS, within a 52.95M to 62.26M COP ICER range. When no drug wastage was considered, ICERs were lower by 19% across all outcomes compared to the base case analysis. Conclusions: Carfilzomib is likely to be a cost-effective treatment option for RRMM patients from a third-party payer perspective in Colombia, attributable to its demonstrated superior clinical profile. Further analysis including other direct medical costs, discounts and survival estimate variations is warranted to assess additional foreseeable gains/savings.

A comparison of mixture cure fraction models to traditional parametric survival models in estimation of the cost-effectiveness of nivolumab for relapsed small cell lung cancer

“…al. that also took a U.S. payer perspective15 . In that study, the authors used a partitioned survival model framework with a standard parametric survival extrapolation to calculate long-term nivolumab OS (generalized gamma distribution).…”