PCN79 AN ECONOMIC EVALUATION OF NIVOLUMAB COMPARED WITH DOCETAXEL AS THE SECOND-LINE TREATMENT FOR PATIENTS WITH ADVANCED NSCLC IN CHINA USING MARKOV MODEL AND PARTITIONED SURVIVAL MODEL

Abstract

This study aimed to evaluate the cost-effectiveness of nivolumab versus docetaxel as the second-line treatment for patients with advanced non-small cell lung cancer (NSCLC). A three-state Markov model and a partitioned survival (PS) model were conducted from the healthcare system perspective to calculate the lifetime incremental cost-effectiveness ratio (ICER) of nivolumab compared with docetaxel. Clinical data came from the landmark RCT Checkmate 078, which was mainly based on the Chinese population. The survival curves of nivolumab and docetaxel were reconstructed independently, and different parametric survival distributions were further used for fitting and extrapolating the curves. The optimal distributions were determined by the AIC/BIC. Cost inputs were derived from government documents of 10 representative provinces in China, the published literature and expert opinions to reflect the real-world situation. Utilities were derived from published literature. AEs were also considered in costs and utilities. Costs and outcomes were discounted at the annual rate of 5%. Sensitivity analyses and scenario analyses were also performed. In base-case analysis, the Markov model showed that compared to docetaxel, nivolumab had an ICER of $81,379/QALY. In the sensitivity analysis, one-way sensitivity analysis showed that the weight of the cohort, the cost of nivolumab and the health state utilities had a significant impact on the ICER. Monte-Carlo Simulation showed that the base-case result was robust, with more than 99% of scattered points fell above the WTP threshold in China ($30,297/QALY) on the cost-effectiveness plane. PS model showed that the ICER equaled to $81,615/QALY, which was in line with the results of the Markov model. The incremental QALY (0.46) was consistent with the Western population-based studies (0.16-0.66). Although nivolumab is recommended by many guidelines, currently it’s not cost-effectiveness as the second-line treatment of advanced NSCLC in China compared with docetaxel.