Abstract
Objective: This study evaluated the cost-effectiveness of nivolumab plus ipilimumab vs. chemotherapy in the first-line setting for patients with advanced non-small-cell lung cancer (NSCLC) from the US payer perspective.Materials and methods: A Markov model wasdeveloped to evaluate the cost and effectiveness of nivolumab plus ipilimumab vs. chemotherapy in the first-line treatment of advanced NSCLC. The survival benefits of nivolumab plus ipilimumab were based on the results of the CheckMate 227 trial. The main endpoints of the model were cost, life-years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratio (ICER). Univariable and probabilistic sensitivity analyses were conducted to assess model uncertainty. Additonal subgroup analyses were also performed.Results: nivolumab plus ipilimumab produced a gain of 0.62 QALYs, at a cost of $104238 per QALY. The variables that had the greatest influence on the ICER were body weight and overall survival (OS) hazard ratio (HR). The probability of nivolumab plus ipilimumab being cost-effectiveness compared to chemotherapy is 50.7 and 66.2% when the willingness-to-pay (WTP) value is $ 100,000 and $ 150,000 per QALY. The results of subgroup analyses showed the ICER remained below $150,000/QALY regardless of the PD-L1 expression level.Conclusions: nivolumab plus ipilimumab was estimated to be cost-effective compared with chemotherapy for patients with advanced NSCLC at a WTP threshold from 100,000/QALY to 150,000/QALY.
Highlights
Lung cancer is the leading cause of cancer-related deaths worldwide, accounting for 18.4% of all cancers in 2018 (Bray et al, 2018)
The results showed that the overall survival (OS) of nivolumab plus ipilimumab was longer than chemotherapy regardless of the progressed disease (PD)-L1 expression level
Since the health-related quality of life was not reported in the CheckMate 227 trial, baseline utility estimates for progression-free survival (PFS) and progressed disease (PD) health states and utility values for adverse effects (AEs) were obtained from previously published studies based on patients with non-small-cell lung cancer (NSCLC)
Summary
Lung cancer is the leading cause of cancer-related deaths worldwide, accounting for 18.4% of all cancers in 2018 (Bray et al, 2018). In the United States, there were an estimated 222,500 newly diagnosed lung cancer cases in 2017 (Siegel et al, 2017), of which 80–85% were non-small-cell lung cancer (NSCLC) cases (American Cancer Society (2020). The introduction of immune checkpoint inhibitors has greatly improved the prognosis of NSCLC (Topalian et al, 2015). Two types of checkpoint inhibitors have been approved for cancer treatment. One is to inhibit the CD28/CTLA-4 system of immune modulation, such as ipilimumab, and the other is to inhibit the interaction between programmed death 1 (PD-1) and programmed cell death 1 ligand 1(PD-L1), such as atezolizumab, avelumab, durvalumab, nivolumab, and pembrolizumab (Reck et al, 2019)
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