Jason Shafrin1, Michelle Skornicki2, Michelle Brauer3, Julie Villeneuve4, Michael Lees5, Nadine Hertel6, John R Penrod7, Jeroen Jansen8. 1. Precision Health Economics, 11100 Santa Monica Blvd. Suite 500, Los Angeles, CA 90025, United States. Electronic address: jason.shafrin@precisionhealtheconomics.com. 2. Precision Health Economics, 11100 Santa Monica Blvd. Suite 500, Los Angeles, CA 90025, United States. Electronic address: michelle.skornicki@precisionhealtheconomics.com. 3. Precision Health Economics, 11100 Santa Monica Blvd. Suite 500, Los Angeles, CA 90025, United States. Electronic address: michelle.brauer@precisionhealtheconomics.com. 4. Bristol-Myers Squibb Canada, 2344 Alfred-Nobel, Suite 300, Saint-Laurent, Québec H4S 0A4, Canada. Electronic address: Julie.Villeneuve@bms.com. 5. Bristol-Myers Squibb, 3 rue Joseph Monier, 92500 Rueil-Malmaison, France. Electronic address: michael.lees@bms.com. 6. Bristol-Myers Squibb, Uxbridge Business Park, Sanderson Road, Uxbridge, Middlesex, UB8 1DH, United Kingdom. Electronic address: Nadine.Hertel@bms.com. 7. Bristol-Myers Squibb, 3401 Princeton Pike, Lawrence Township, NJ 08648, United States. Electronic address: john.penrod@bms.com. 8. Precision Health Economics, 11100 Santa Monica Blvd. Suite 500, Los Angeles, CA 90025, United States. Electronic address: jeroen.jansen@precisionhealtheconomics.com.
Abstract
INTRODUCTION: Health technology appraisal agencies often rely on cost-effectiveness analyses to inform coverage decisions for new treatments. These assessments, however, frequently measure a treatment's value from the payer's perspective, and may not capture value generated from reduced caregiving costs, increased productivity, value based on patient risk preferences, option value or the insurance value to non-patients. METHODS: To examine how using a broader societal perspective of treatment value affects cost-effectiveness estimates, this case study analyzed the net monetary benefit (NMB) of second-line nivolumab treatment of patients with squamous non-small cell lung cancer (NSCLC) in Canada. The comparator was treatment with docetaxel. NMB was measured from three perspectives: (i) traditional payer, (ii) traditional societal and (iii) broad societal. RESULTS: Nivolumab was more effective (increased quality-adjusted life years by 0.66 versus docetaxel), but also increased costs by $100,168 CAD. When valuing a quality-adjusted life year at $150,000, the net monetary benefit from the payer perspective suggested that costs modestly exceed benefits (NMB: -$1031). Adopting a societal perspective, however, nivolumab's benefits outweighed its costs (NMB: +$6752 and +$91,084 from the traditional and broad societal perspectives, respectively). CONCLUSION: Broadening cost-effectiveness analysis beyond the traditional payer perspective had a significant impact on the result and should be considered in order to capture all treatment benefits and costs of societal relevance.
INTRODUCTION: Health technology appraisal agencies often rely on cost-effectiveness analyses to inform coverage decisions for new treatments. These assessments, however, frequently measure a treatment's value from the payer's perspective, and may not capture value generated from reduced caregiving costs, increased productivity, value based on patient risk preferences, option value or the insurance value to non-patients. METHODS: To examine how using a broader societal perspective of treatment value affects cost-effectiveness estimates, this case study analyzed the net monetary benefit (NMB) of second-line nivolumab treatment of patients with squamous non-small cell lung cancer (NSCLC) in Canada. The comparator was treatment with docetaxel. NMB was measured from three perspectives: (i) traditional payer, (ii) traditional societal and (iii) broad societal. RESULTS:Nivolumab was more effective (increased quality-adjusted life years by 0.66 versus docetaxel), but also increased costs by $100,168 CAD. When valuing a quality-adjusted life year at $150,000, the net monetary benefit from the payer perspective suggested that costs modestly exceed benefits (NMB: -$1031). Adopting a societal perspective, however, nivolumab's benefits outweighed its costs (NMB: +$6752 and +$91,084 from the traditional and broad societal perspectives, respectively). CONCLUSION: Broadening cost-effectiveness analysis beyond the traditional payer perspective had a significant impact on the result and should be considered in order to capture all treatment benefits and costs of societal relevance.