Nivolumab Versus Docetaxel for Previously Treated Advanced Non-Small Cell Lung Cancer in China: A Cost-Effectiveness Analysis

Abstract

Background and Objective The economic assessment of immuno-oncology agents in Chinese patients is limited despite a need for new therapies. Nivolumab is the first immune checkpoint inhibitor approved for the second-line treatment of nonsmall cell lung cancer (NSCLC) in China, and it significantly prolongs overall survival. However, considering the high cost of nivolumab, it is urgent to assess its value in China in terms of both efficacy and cost. The objective of this study was to investigate the cost-effectiveness of nivolumab vs docetaxel in the second-line setting for NSCLC patients from the Chinese healthcare system perspective. Methods A Markov model consisting of three health states, was designed to evaluate the lifetime cost and effectiveness of nivolumab vs docetaxel in the second-line treatment of NSCLC patients. Clinical data was derived from the CheckMate 078 phase III clinical trial, which included 504 patients predominantly from China. Parametric survival models to fit and extrapolate survival data were chosen based on clinical rationality, visual fit and statistical goodness-of-fit. Lifetime costs and health outcomes were calculated, and US$28,899 and $63,564 per quality-adjusted life-year (QALY) were selected as the willingness-to-pay (WTP) threshold values for general regions and affluent regions, respectively. One-way and probabilistic sensitivity analyses were undertaken to explore the robustness of the model. Additional subgroup analyses were performed. Results In base case analysis, Nivolumab yielded an additional 0.

Cost effectiveness of immune checkpoint inhibitors for treatment of non-small cell lung cancer: A systematic review

“…The characteristics of all included studies are presented in S1 Table. Most of the studies were conducted in 2019 [28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Studies were conducted from countries all over the world, with ten from the USA [22-27, 29, 30, 32, 33], seven from China (one from HongKong) [34][35][36][38][39][40][41], two from Canada [20,37], and one each from Australia [31], France [28] and Switzerland [21]. Most studies were assessed from the perspective of health care system (N = 12) [20-22, 25, 26, 28-31, 35, 37, 40], some used a payer perspective (N = 8) [23,24,27,32,33,38,39,41], and the remainder used a perspective of society (N = 1) [34] and hospital authority (N = 1) [36].…”

“…Subsequently, plenty of economic studies around the world also evaluated the cost-effectiveness of second-line therapies for patients with recurrent NSCLC. Three studies, one each from Switzerland, US and China, showed that nivolumab is not cost-effective compared with docetaxel for patients with previously treated advanced NSCLC [21,31,35]. Huang et al [24] found that pembrolizumab is cost-effective versus docetaxel in pre-treated advanced NSCLC patients with PD-L1 � 50% from the US third-party payer perspective.…”

<p>Economic Evaluations of Immune Checkpoint Inhibitors for Patients with Non-Small Cell Lung Cancer: A Systematic Review</p>

“…Four studies were conducted in China, and one of them was conducted in the Hong Kong region. Fourteen, 21,22,[24][25][26][27][28][29][30][31]34,[38][39][40] four, 33,[35][36][37] and three 12,23,32 studies focused on pembrolizumab, nivolumab, and atezolizumab, respectively. No study investigated durvalumab.…”

“…Most of them reported the results in terms of cost per quality-adjusted life years (QALYs) and cost per life year (LY) gained. Among these studies, 16 12,21-31,34,38-40 and 5 32,33,[35][36][37] were about firstand second-line treatments for NSCLC, respectively. One study 12 had two base cases.…”

“…About half of the studies 12,[22][23][24][25][28][29][30][31]33,36,38,39 did not provide reasons for their selected decision-analytic model nor report heterogeneity. Most studies 12,[21][22][23][24][25][26][27][28][31][32][33][34]37,39,40 did not mention whether there was preference measurement and evaluation. Many studies 12,22,23,25,26,28,30,31,34,35,37,38,40 did not report currency, price date and conversion.…”