A Cost‐Effectiveness Analysis of Nivolumab versus Docetaxel for Advanced Nonsquamous NSCLC Including PD‐L1 Testing. Issue 11 (November 2016)

• Record Type: Journal Article
• Authors: Matter‐Walstra, Klazien; Schwenkglenks, Matthias; Aebi, Stefan; Dedes, Konstantin; Diebold, Joachim; Pietrini, Mario; Klingbiel, Dirk; von Moos, Roger; Gautschi, Oliver
• Is Part Of: Journal of thoracic oncology. Volume 11:Issue 11(2016)
• Publication Date: 2016-11
• Subjects: Lung cancer -- Nivolumab -- Docetaxel -- Cost‐effectiveness -- QALY -- ICER; Chest -- Cancer -- Periodicals; Thoracic Neoplasms -- Periodicals; 616.99494005
• DOI: 10.1016/j.jtho.2016.05.032
• Languages: English
• ISSNs: 1556-0864

Abstract

ABSTRACT : Introduction : Nivolumab (NIV) was recently approved in several countries for patients with pretreated advanced NSCLC. NIV is not cost‐effective compared with docetaxel (DOC) for the treatment of squamous NSCLC. However, its cost‐effectiveness for nonsquamous NSCLC and the consequences of programmed death ligand 1 (PD‐L1) testing are unknown. Methods : This literature‐based health economic study used CheckMate‐057 trial data to model the incremental cost‐effectiveness ratio (ICER) of NIV versus DOC in the Swiss health care setting. The effect of PD‐L1 positivity for patient selection was assessed. Results : In the base case model, NIV (mean cost CHF66, 208; mean effect 0.69 quality‐adjusted life‐years [QALYs]) compared with DOC (mean cost CHF37, 618; mean effect 0.53 QALYs) resulted in an ICER of CHF177, 478/QALY gained. Treating only patients with PD‐L1–positive tumors (threshold ≥10%) with NIV compared with treating all patients with DOC produced a base case ICER of CHF124, 891/QALY gained. Reduced drug price, dose, or treatment duration decreased the ICER partly below a willingness‐to‐pay threshold of CHF100, 000/QALY. Health state utilities strongly influenced cost‐effectiveness. Conclusions : Compared with DOC, NIV is not cost‐effective for the treatment of nonsquamous NSCLC at current prices in the Swiss health care setting. Price reduction or PD‐L1 testing and selection of patients for NIV on the basis of test positivity improves cost‐effectiveness compared with DOC.