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J Thorac Oncol. 2016 Nov;11(11):1846-1855. doi: 10.1016/j.jtho.2016.05.032. Epub 2016 Jun 14.

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

Author information

1
Swiss Group for Clinical Cancer Research Coordinating Centre, Bern, Switzerland; Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland. Electronic address: Klazien.Matter@unibas.ch.
2
Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland.
3
Swiss Group for Clinical Cancer Research Coordinating Centre, Bern, Switzerland; Medical Oncology, Department of Internal Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland.
4
Department of Gynaecology, University Hospital Zürich, Zürich, Switzerland.
5
Institute of Pathology, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland.
6
Medical Controlling, Cantonal Hospital Lucerne, Lucerne, Switzerland.
7
Swiss Group for Clinical Cancer Research Coordinating Centre, Bern, Switzerland.
8
Swiss Group for Clinical Cancer Research Coordinating Centre, Bern, Switzerland; Medical Oncology, Cantonal Hospital Graubünden, Chur, Switzerland.

Abstract

INTRODUCTION:

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.

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.

KEYWORDS:

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

PMID:
27311996
DOI:
10.1016/j.jtho.2016.05.032
[Indexed for MEDLINE]
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