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M. Pietrini
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P3.07 - Poster Session with Presenters Present (ID 493)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Regional Aspects/Health Policy/Public Health
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.07-001 - Nivolumab for Patients with Advanced Non-Squamous Non-Small Cell Lung Cancer: A Cost-Effectiveness Analysis including PD-L1 Testing (ID 3741)
14:30 - 14:30 | Author(s): M. Pietrini
- Abstract
Background:
Nivolumab (NIV) is approved in several countries for pre-treated patients with advanced non-small cell lung cancer (NSCLC). UK NICE previously reported that NIV is not cost-effective compared with DOC for the treatment of squamous NSCLC. Here, we report cost-effectiveness for nonsquamous NSCLC, and consequences of patient selection by PD-L1 testing.
Methods:
Based on the published results of the CheckMate-057 trial (Borghaei et al, NEJM 2015), we performed a literature-based health economic modelling study to estimate the incremental cost-effectiveness ratio (ICER) of NIV versus DOC for the Swiss health care setting. We estimated the probability of reaching cost-effectiveness based on a willingness to pay (WTP) threshold of CHF100’000 per QALY gained. Moreover, we implemented patient selection for NIV treatment using PD-L1 staining, and modelled the effect of reducing the NIV price, dose, and treatment duration, on the ICER.
Results:
In the base case model, NIV (mean costs CHF 66’208; mean effect 0.69 QALYs) compared to DOC (mean costs CHF 37'618; mean effect 0.53 QALYs) resulted in an ICER of CHF 177’478 per QALY gained. Selecting patients for NIV by PD-L1 testing (threshold ≥10%), resulted in a base case ICER of CHF124’891 per QALY gained, compared to treating all patients with DOC. Reduction of NIV price, dose, or treatment duration, all reduced the ICER partially below an assumed WTP of CHF100’000 per QALY (see Table 1). Cost-effectiveness was strongly influenced by health state utilities. Table 1 Results of the base case and scenario analyses
DOC= docetaxel, NIV=Nivolumab, QALY= quality adjusted life years, ICER= incremental cost effectiveness ratio, CHF=Swiss FrancsScenario Treatment arm Cost (mean) Effect Month (mean) Effect QALY (mean) Compared to Incremental costs Incremental effect ICER CHF probability cost- effective Base case DOC 37'618 10.99 0.53 NIV 66’208 15.42 0.69 DOC 28’589 0.16 177’478 14.1% PD-L1 ≥1% 74'968 17.26 0.79 DOC 35’530 0.27 133’267 19.7% NIV 6'941 0.11 65’774 85.2% PD-L1 ≥10% 69’893 16.83 0.78 DOC 32’274 0.26 124’891 22.1% NIV 3’685 0.10 37’860 86.7%
Conclusion:
At its current price, NIV is not cost-effective compared with DOC for the treatment of patients with nonsquamous NSCLC. Price reduction and/or patient selection by PD-L1 testing would be highly recommendable from a socio-economic viewpoint.
