Cost-effectiveness analysis of nivolumab for the treatment of squamous cell carcinoma of the head and neck in the United States. (3rd May 2020)

• Record Type: Journal Article
• Authors: Haddad, Robert; Cohen, Ezra E.W.; Venkatachalam, Meena; Young, Kate; Singh, Prianka; Shaw, James W.; Korytowsky, Beata; Abraham, Pranav; Harrington, Kevin J.
• Is Part Of: Journal of medical economics. Volume 23:Number 5(2020)
• Page Start: 442
• Page End: 447
• Publication Date: 2020-05-03
• Subjects: CheckMate 141 study -- cost-effectiveness -- nivolumab -- quality-adjusted life-years -- recurrent/metastatic -- sensitivity analyses -- squamous cell carcinoma of the head and neck -- treatment options; I10 -- I00 -- I11; Medical care -- Cost control -- Periodicals; Medical economics -- Periodicals; 362.10941
• DOI: 10.1080/13696998.2020.1715414
• Languages: English
• ISSNs: 1369-6998

Abstract

Abstract: Aim: To assess the cost-effectiveness of nivolumab monotherapy for recurrent/metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN) in the US. Methods: We constructed a cohort-based partitioned survival model for three health states (progression-free, progressed disease, and death). Using overall survival and progression-free survival data from the nivolumab and investigator's choice (IC) arms of the CheckMate 141 study, the proportion of patients in each health state was estimated by parametric modeling over a 25-year period. Cost, utility, adverse event, and disease management data inputs were obtained from relevant literature and applied to patients in each health state. A scenario analysis was conducted assuming increased uptake of subsequent immunotherapies. A one-way deterministic sensitivity analysis assessed the impact of variation in multiple parameters. A probabilistic sensitivity analysis in which probabilistic distributions were applied to each input during 1, 000 model iterations was also conducted. Results: Total costs incurred were higher with nivolumab ($101, 552) than with IC ($38, 067). Nivolumab was associated with a higher number of life-years (LY; 1.21) and quality-adjusted life-years (QALYs; 0.89), compared with IC (0.68 and 0.42, respectively). The incremental cost-effectiveness ratio for nivolumab compared with IC was $134, 438 per QALY, and this remained qualitatively similar when increased uptake of subsequent immunotherapies was assumed ($129, 603 per QALY). Sensitivity analyses supported these findings. Conclusions: These results suggest that, at a willingness-to-pay threshold of $150, 000 per QALY, nivolumab is a cost-effective option for therapy of SCCHN in the US.