Cost-Effectiveness Analysis of Nivolumab Plus Ipilimumab vs. Chemotherapy as First-Line Therapy in Advanced Non-Small Cell Lung Cancer

Abstract

Background: The CheckMate 227 trial has indicated that nivolumab plus ipilimumab compared with chemotherapy significantly increases long-term survival in the first-line setting of advanced non-small-cell lung cancer (NSCLC). Methods: A Markov model was built to estimate the cost and effectiveness of nivolumab plus ipilimumab vs. chemotherapy as the first-line therapy in patients with advanced NSCLC based on outcomes data from the CheckMate 227 trial. We calculated the cost and health outcomes at a willingness-to-pay (WTP) threshold of $150,000 per quality adjusted life year (QALY) in populations with different programmed death ligand 1 (PD-L1) expression levels (≥50, ≥1, and <1%) or a high tumor mutational burden (TMB) (≥10 mutations per megabase). Sensitivity analysis were used to test the model stability.

Cost-effectiveness of Nivolumab-Ipilimumab Combination Therapy for the Treatment of Advanced Non–Small Cell Lung Cancer

“…The researchers used a higher willingness-to-pay threshold ($150 000 per QALY) and concluded that nivolumab-ipilimumab combination therapy could be considered cost-effective among patients with a PD-L1 level of less than 1%. The second study 51 also found slightly lower ICERs when comparing nivolumab-ipilimumab combination therapy with chemotherapy ($107 404 per QALY vs $172 589 per QALY, respectively) and used a willingness-to-pay threshold of $150 000 per QALY. In contrast to the first study, researchers in the second study concluded that nivolumab-ipilimumab combination therapy could be considered cost-effective among patients with PD-L1 levels of 50% or higher and 1% or higher but not among patients with PD-L1 levels of less than 1%.…”

“…To our knowledge, 2 studies exist on the cost-effectiveness of nivolumab-ipilimumab combination therapy for the treatment of advanced NSCLC. 50 , 51 The first study 50 reported slightly lower ICERs when comparing nivolumab-ipilimumab combination therapy with chemotherapy ($143 434 per QALY vs $180 307 per QALY, respectively). The researchers used a higher willingness-to-pay threshold ($150 000 per QALY) and concluded that nivolumab-ipilimumab combination therapy could be considered cost-effective among patients with a PD-L1 level of less than 1%.…”

Cost-Effectiveness of Nivolumab Plus Ipilimumab as First-Line Therapy in Advanced Non–small-cell Lung Cancer

“…The potential reason is that maintenance chemotherapy is considered in nonsquamous tumors, which substantially augments the cost of chemotherapy in nonsquamous tumors compared with squamous tumors. The recent two economic analyses showed the opposite results (Hu et al, 2020;Courtney et al, 2021), which might be led by the different gained health outcomes. However, nivolumab plus ipilimumab is not a cost-effective option in the Chinese context because its ICER exceeded the local threshold of $27,351/QALY.…”

Determining the optimal PD‐1/PD‐L1 inhibitors for the first‐line treatment of non‐small‐cell lung cancer with high‐level PD‐L1 expression in China

“…Additionally, the survival status of cancer patients changes over time, and it is therefore very important for economic analyses to appropriately simulate the survival status. 29 , 30 The Kaplan–Meier survival curve can reflect the changes in the survival state over a period of time, but it is difficult to obtain the original data and evaluate the whole life cycle. Kaplan–Meier survival curves can reflect survival changes over time, but it is difficult to extract the original data and evaluate the entire life cycle.…”