POSC162 Cost Effectiveness Analysis of Nivolumab Plus Ipilimumab Therapy in Patients with Advanced Non-Small Cell Lung Cancer in Japan

Abstract

This study aimed to evaluate the cost-effectiveness of combination therapy of nivolumab plus ipilimumab (NIV+IPI) for patients with advanced non-small-cell lung cancer (NSCLC), comparing with platinum-doublet chemotherapy in Japanese settings. A partitioned survival model was developed to predict costs and quality-adjusted life years (QALYs) in a NIV+IPI arm and a chemotherapy arm. Data on overall survival and progression-free survival was derived from the CheckMate 227 trial. Cost estimates were based on Japanese healthcare system perspective, by using real world data, JMDC claims database. Utilities were derived from published sources outside Japan. The incremental cost-effectiveness ratio (ICER) of NIV+IPI therapy compared with chemotherapy was estimated. A subgroup analysis on the level of PD-L1 expression (≥1% or not) was conducted. In addition, deterministic sensitivity analysis was performed to assess the uncertainty in parameter settings. Compared with chemotherapy, NIV+IPI therapy incurred an additional cost of USD166,984 and conferred an additional 0.81 QALY, which resulted in an ICER of USD205,141/QALY gained. Contrary to prior expectations, the ICER of patients with a PD-L1 expression level ≥1% was higher than that of patients with a PD-L1 expression level <1% (USD241,734/QALY and USD129,288/QALY, respectively). Sensitivity analyses showed a relatively robust result that the ICERs remined higher than a Japanese price adjustment threshold of USD75,000/QALY over the full range of model parameters. The combination therapy of nivolumab plus ipilimumab as first-line therapy would not be cost-effective under a willingness-to-pay threshold of USD75,000/QALY. However, a better cost-effectiveness was found in the subgroup with a PD-L1 expression level <1%, which needs further research to elucidate the heterogeneity and specific biological mechanisms.