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

Courtney, P Travis; Yip, Anthony; Cherry, Daniel; Salans, Mia; Kumar, Abhishek; Murphy, James D.

doi:10.1001/jamanetworkopen.2021.8787

Cited by 32 publications

(33 citation statements)

References 54 publications

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“…This finding could be attributed to a lower survival benefit of N+I versus chemotherapy in PD-L1 ≥ 1% subgroup than that in PD-L1 < 1% subgroup ( 6 ). Similar ICER results were also recognized in two previous studies ( 17 , 18 ). Although exploratory analysis of the trial showed that N+I provided preferable survival benefits in patients with PD-L1 ≥ 50% or high tumor mutational burden, we did not perform these subgroup analyses because of the absence of valid data.…”

Section: Discussionsupporting

confidence: 91%

“…Although several investigations have shown a single-agent ICI with or without chemotherapy to be cost-effective (11)(12)(13)(14)(15), doubleagent ICI combinations incur more costs than single-ICI regimens. To date, three studies have estimated the cost-effectiveness of N+I versus chemotherapy and displayed different results (16)(17)(18). Another recently published study found that the incremental costeffectiveness ratio (ICER) of N+I+chemotherapy versus chemotherapy alone was $202,275 per quality-adjusted life year (QALY) (19).…”

Section: Introductionmentioning

confidence: 99%

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Cost-Effectiveness of Nivolumab Plus Ipilimumab With and Without Chemotherapy for Advanced Non-Small Cell Lung Cancer

et al. 2021

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BackgroundFirst-line treatment with nivolumab plus ipilimumab (N+I) or nivolumab plus ipilimumab with two cycles of chemotherapy (N+I+chemotherapy) improve overall survival and progression-free survival for patients with metastatic non-small cell lung cancer (NSCLC), yet researchers have not concomitantly compared the cost-effectiveness of N+I and N+I+chemotherapy with chemotherapy alone.Materials and methodsUsing outcomes data from the CheckMate 227 and CheckMate 9LA phase 3 randomized trials, we developed a Markov model with lifetime horizon to compare the costs and effectiveness of N+I and N+I+chemotherapy versus chemotherapy from the U.S. health care sector perspective. Subgroup analysis by programmed death-ligand 1 (PD-L1) expression levels (≥1% and <1%) and probabilistic analysis were performed.ResultsThe incremental cost-effectiveness ratio (ICER) of N+I versus chemotherapy was $239,072 per QALY, and $838,198 per QALY for N+I+chemotherapy versus N+I. The ICER of N+I versus chemotherapy was $246,584 per QALY for patients with PD-L1 ≥ 1% and $185,620 per QALY for those with PD-L1 < 1%. In probabilistic analysis, N+I had a 2.6% probability of being cost-effective at a willingness-to-pay threshold of $150,000 per QALY. The probability was 0.4% for patients with PD-L1 ≥ 1% and 10.6% for patients with PD-L1 < 1%.ConclusionFirst-line N+I or N+I+chemotherapy for metastatic NSCLC was not cost-effective regardless of PD-L1 expression levels from the U.S. health care sector perspective.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Nivolumab Plus Ipilimumab With and Without Chemotherapy for Advanced Non-Small Cell Lung Cancer

et al. 2021

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“…Therefore, the utility values and treatment costs for AEs in our model were obtained from other published literature. 23 , 24 , 26 We assumed that AEs occurred only in the first cycle. Precise utility scores were not available in the original or previous MPM literature.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness analysis of nivolumab plus ipilimumab versus chemotherapy as the first-line treatment for unresectable malignant pleural mesothelioma

Liu

Cao

et al. 2022

Ther Adv Med Oncol

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Introduction: This study evaluated the cost-effectiveness of nivolumab plus ipilimumab (NI) versus pemetrexed plus cisplatin/carboplatin (C) as the first-line treatment for unresectable malignant pleural mesothelioma (MPM) from the perspective of US payers. Methods: A 10-year partitioned survival model was constructed using survival and safety data from the CheckMate 743 clinical trial. The output metrics of the model included the patient’s lifetime quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratio (ICER). Only direct medical costs were considered. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of the results. Results: Among all randomized patients, group NI had an ICER of $475,677/QALY relative to group C. Among patients with epithelioid histology, group NI had an ICER of $760,955/QALY. Among patients with non-epithelioid histology, group NI had an ICER of $418,348/QALY. The ICERs of all three populations exceeded the willingness-to-pay threshold ($150,000). The results of one-way sensitivity analysis revealed that the cost of nivolumab had a great influence on the results. The results of probabilistic sensitivity analysis demonstrated that the possibility of NI being more economical in all randomized patients and in patients with non-epidemiology histology was 0. In patients with epithelioid histology, the probability that NI had an economic advantage was 0.6%. Conclusions: From the perspective of US payers, in patients with unresectable MPM, NI has no economic advantage over C.

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“…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.…”

Section: Discussionmentioning

confidence: 97%

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

Hao

Shen

Wu³

2021

Front. Pharmacol.

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Purpose: The effectiveness of nivolumab plus ipilimumab for advanced non-small cell lung cancer (NSCLC) has been demonstrated. Decisions have to be made about allocating healthcare resources. Economic evidence could support policy decisions to fund expensive interventions. The current analysis evaluated the cost-effectiveness of nivolumab plus ipilimumab in advanced NSCLC harboring no EGFR or ALK mutations. It is set in the context of the US and China, representing developed and resource-constrained settings, respectively.Patients and Methods: A Markov model consisting of three discrete health states was used to assess the cost-effectiveness of nivolumab plus ipilimumab vs. chemotherapy. The key clinical data were derived from the CheckMate-227 trial, and the cost and health preference data were derived from the literature. Costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs) and incremental net health benefits (INHBs) were calculated for the two strategies. Subgroup, one-way and probabilistic sensitivity analyses were performed.Results: In the United States, nivolumab plus ipilimumab increased by 1.260 QALYs with an additional cost of $95,617 compared with the features of chemotherapy, which led to an ICER of $75,871 per QALY gained. INHB indicated that nivolumab plus ipilimumab treatment had a 99% probability of being cost-effective at the ICER threshold of $100,000/QALY in all subgroups. The results of sensitivity analyses revealed that the model outcomes were robust. In China, the ICER of nivolumab plus ipilimumab vs. chemotherapy was $59,773/QALY, and the INHB was -1.972 QALY at the threshold of $27,351/QALY.Conclusion: Nivolumab plus ipilimumab treatment is a cost-effective option compared with chemotherapy for patients with advanced NSCLC harboring no EGFR or ALK mutations in the United States. However, nivolumab plus ipilimumab is not a preferred option in China.

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

Cited by 32 publications

References 54 publications

Cost-Effectiveness of Nivolumab Plus Ipilimumab With and Without Chemotherapy for Advanced Non-Small Cell Lung Cancer

Cost-Effectiveness of Nivolumab Plus Ipilimumab With and Without Chemotherapy for Advanced Non-Small Cell Lung Cancer

Cost-effectiveness analysis of nivolumab plus ipilimumab versus chemotherapy as the first-line treatment for unresectable malignant pleural mesothelioma

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

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