Klazien Matter-Walstra1, Matthias Schwenkglenks2, Stefan Aebi3, Konstantin Dedes4, Joachim Diebold5, Mario Pietrini6, Dirk Klingbiel7, Roger von Moos8, Oliver Gautschi3. 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.
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.
Authors: Kathryn R Tringale; Kate T Carroll; Kaveh Zakeri; Assuntina G Sacco; Linda Barnachea; James D Murphy Journal: J Natl Cancer Inst Date: 2018-05-01 Impact factor: 13.506
Authors: Steven D Criss; Meghan J Mooradian; Deirdre F Sheehan; Leyre Zubiri; Melissa A Lumish; Justin F Gainor; Kerry L Reynolds; Chung Yin Kong Journal: JAMA Oncol Date: 2019-03-01 Impact factor: 31.777