Modelled Economic Evaluation of Nivolumab for the Treatment of Second-Line Advanced or Metastatic Squamous Non-Small-Cell Lung Cancer in Australia Using Both Partition Survival and Markov Models.

OBJECTIVES: To assess the cost-effectiveness of nivolumab for patients with advanced or metastatic squamous non-small-cell lung cancer (NSCLC) progressed on or after platinum-based chemotherapy using a modelled economic evaluation.

METHODS: Both partition survival (PS) and Markov models, comprised of three health states, were adopted to evaluate the cost-effectiveness of nivolumab compared to docetaxel from an Australian healthcare system perspective with a 6-year time horizon. Reconstructed individual patient data (IPD) were derived from published Kaplan-Meier curves from the pivotal trial for overall survival (OS) and progression-free survival (PFS) using a validated algorithm. Best-fitting survival curves were selected to extrapolate the OS, PFS and post-progression survival (PPS) beyond trial duration. Expected costs and health outcomes [i.e. quality-adjusted life year (QALY), and life year (LY)] associated with each of the health states (i.e. PF, PD and dead) were accrued over the time horizon. Both deterministic and probabilistic sensitivity analyses were undertaken.

RESULTS: Nivolumab was associated with both higher costs and benefits in both PS and Markov models. In particular, from the PS model, nivolumab cost an additional A$198,862/QALY and A$181,623/LY gained. The Markov model showed that nivolumab had an incremental cost-effectiveness ratio (ICER) of A$220,029/QALY and A$193,459/LY, respectively. The sensitivity analyses showed base-case results were sensitive to the extrapolation approach, duration of treatment, cost of nivolumab and time horizon modelled.

CONCLUSIONS: Using an often-quoted willingness-to-pay per QALY threshold in Australia (i.e. A$50,000), the treatment with nivolumab cannot be considered cost-effective. It might be funded publicly by special arrangements given unmet clinical needs for patients.