Cost Effectiveness of Nivolumab in Patients with Advanced, Previously Treated Squamous and Non-squamous Non-small-cell Lung Cancer in England

Abstract

Objective The aim of this study was to investigate the cost effectiveness of nivolumab versus docetaxel in previously treated, advanced non–small-cell lung cancer (NSCLC) in England and assess how conditional reimbursement within the Cancer Drugs Fund (CDF) can be used to ensure timely patient access to effective treatments. Methods Cost-effectiveness models developed for the National Institute for Health and Care Excellence (NICE) TA483 (squamous) and TA484 (non-squamous) technology appraisals were supplemented with updated overall survival (OS), progression-free survival (PFS), and time-to-treatment discontinuation data collected as part of the CDF data collection agreement. Both models were developed by using a partitioned-survival approach based on PFS and OS predictions from CheckMate 017 and CheckMate 057 to estimate the projected proportion of patients in each health state (progression free, progression, death) throughout the model’s time horizon. The primary outcomes were estimated costs, quality-adjusted life-years (QALYs), and the resulting incremental cost-effectiveness ratio (ICER) expressed as cost/QALY gained. Results Base-case ICERs for treating patients with nivolumab versus docetaxel were £35,657/QALY and £38,703/QALY for squamous and non-squamous NSCLC patients, respectively, which are substantially lower than those obtained from what were deemed to be the most appropriate analyses for decision making in the original submissions when run with the same patient access scheme discount: £68,576/QALY and £73,189/QALY gained for squamous and non-squamous NSCLC, respectively. Conclusions Nivolumab versus docetaxel is cost effective for treating locally advanced/metastatic NSCLC after prior chemotherapy in adults, regardless of tumour histology or programmed death-ligand 1 expression status. Supplementary Information The online version contains supplementary material available at 10.1007/s41669-020-00245-4.

PD-L1 Test-Based Strategy With Nivolumab as the Second-Line Treatment in Advanced NSCLC： A Cost-Effectiveness Analysis in China

“…From a Chinese healthcare system perspective, our previous cost-effectiveness analysis revealed that second-line nivolumab was unlikely to be cost-effective compared with docetaxel in patients with advanced NSCLC, despite the subgroup analysis showing the improved cost-effectiveness of nivolumab in the patients with PD-L1TPS ≥1% ( 12 ). Although this finding did not concur with the cost-effectiveness analyses conducted in other countries showing a favorable cost-effectiveness of nivolumab versus docetaxel in previously treated advanced NSCLC patients regardless of PD-L1 expression ( 13 , 14 ), different perspectives, trial source used for analysis, and approach to modeling used between these studies have to be highlighted that may explain the inconsistency. Considering that nivolumab is recommended as the preferred second-line treatment for advanced NSCLC patients without ALK or EGFR mutations regardless of their PD-L1 expression in China, evidence regarding the impact of PD-L1 test results on the comparative cost-effectiveness of second-line nivolumab versus docetaxel from a Chinese health system perspective is urgently needed to inform Chinese healthcare policy making.…”

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

“…20,31,52 However, for the treatment of advanced melanoma [53][54][55] and metastatic colorectal cancer, 56 nivolumabipilimumab combination therapy was not found to be cost-effective compared with a variety of other treatments, including both immunotherapy and chemotherapy. Several cost-effectiveness studies [57][58][59][60][61][62][63] have investigated nivolumab monotherapy as second-line treatment for patients with advanced NSCLC. Many studies have compared nivolumab monotherapy with docetaxel monotherapy, and most of those studies have found that nivolumab was not cost-effective compared with docetaxel in a variety of health care settings.…”

“…Many studies have compared nivolumab monotherapy with docetaxel monotherapy, and most of those studies have found that nivolumab was not cost-effective compared with docetaxel in a variety of health care settings. [57][58][59][60][61][62] In addition, nivolumab was not found to be cost-effective compared with erlotinib 57 and nivolumab was dominated by atezolizumab (ie, less effective and more expensive than atezolizumab). 63 However, the results of 2 other studies have suggested that introducing PD-L1 testing or basing treatment on different PD-L1 expression thresholds may improve the cost-effectiveness of nivolumab.…”

Cost-Effectiveness of Tislelizumab Versus Docetaxel for Previously Treated Advanced Non-Small-Cell Lung Cancer in China

“…Several economic studies around the world assessed the ICIs as second-line treatments for NSCLC, and the cost-effectiveness results were inconsistent among different countries. A total of three studies, one each from Switzerland ( Matter-Walstra et al, 2016 ), Australia ( Gao and Li, 2019 ), and England ( Rothwell et al, 2021 ) showed that nivolumab is not cost-effective compared with docetaxel for patients with previously treated advanced NSCLC except in England. One US-based study found that pembrolizumab is cost-effective versus docetaxel for second-line treatment of advanced NSCLC patients with PD-L1 ≥50% ( Huang et al, 2017 ).…”