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

作者：Matter Walstra Klazien; Schwenkglenks Matthias; Aebi Stefan; Dedes Konstantin; Diebold Joachim; Pietrini Mario; Klingbiel Dirk; von Moos Roger; Gautschi Oliver

来源：Journal of Thoracic Oncology, 2016, 11(11): 1846-1855.

DOI：10.1016/j.jtho.2016.05.032

• Lung cancer
• Nivolumab
• Docetaxel
• Cost-effectiveness
• QALY
• ICER

Introduction: Nivolumab (NW) 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.
Methods: 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.
Results: 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.
Conclusions: 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.

• 出版日期2016-11