A Cost-Effectiveness Analysis of Nivolumab versus Docetaxel for Advanced Nonsquamous NSCLC Including PD-L1 Testing

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...

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Bibliographic Details
Published in:	Journal of thoracic oncology 2016-11, Vol.11 (11), p.1846-1855
Main Authors:	Matter-Walstra, Klazien, Schwenkglenks, Matthias, Aebi, Stefan, Dedes, Konstantin, Diebold, Joachim, Pietrini, Mario, Klingbiel, Dirk, von Moos, Roger, Gautschi, Oliver
Format:	Article
Language:	eng
Subjects:	Antibodies, Monoclonal - economics Antibodies, Monoclonal - therapeutic use Antineoplastic Agents - economics Antineoplastic Agents - therapeutic use B7-H1 Antigen - metabolism Carcinoma, Non-Small-Cell Lung - drug therapy Carcinoma, Non-Small-Cell Lung - pathology Cost-Benefit Analysis Cost-effectiveness Docetaxel Female Humans ICER Lung cancer Lung Neoplasms - drug therapy Lung Neoplasms - pathology Male Nivolumab QALY Quality-Adjusted Life Years Taxoids - economics Taxoids - therapeutic use
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Summary:	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. 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. 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. 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.
ISSN:	1556-0864 1556-1380