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T. Schmidt
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P3.07 - Immunology and Immunotherapy (ID 723)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Immunology and Immunotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.07-013 - Cost-Effectiveness of Immune Checkpoint Inhibitors in the Treatment of Advanced Non-Small Cell Lung Cancer (ID 9844)
09:30 - 09:30 | Author(s): T. Schmidt
- Abstract
Background:
Non-small cell lung cancer (NSCLC) is a leading cause of cancer related death worldwide. Late diagnosis and poor prognosis of advanced cancer are considered to be the main causes for the high mortality rates in NSCLC. Immune checkpoint inhibitors targeting programmed cell death protein 1 (PD1) demonstrated substantial improvements in overall survival (OS) compared with chemotherapy in previously treated patients with advanced NSCLC. However, the annual therapy costs are high (>EUR100,000 in Germany). The objectives of this study are to assess the cost-effectiveness of nivolumab and pembrolizumab in previously treated patients with advanced NSCLC from the perspective of the German statutory health insurance.
Method:
We developed a microsimulation model (discrete event simulation) to simulate the results of clinical trials and to extrapolate outcomes beyond the study duration. Clinical input parameters were gathered from published trial data (CheckMate017, CheckMate057, KEYNOTE-010). Kaplan-Meyer curves of progression free survival and OS were digitally reconstructed and survival analyses were conducted to inform model survival parameters. Utilities and cost data were extracted from published literature and German price databases. Cost-effectiveness analysis was performed for various PD-L1 expression levels. In each scenario, a Monte Carlo simulation with 10,000 iterations was performed to capture parameter uncertainty.
Result:
Additional cost per quality adjusted life year (QALY) gained of nivolumab vs. docetaxel in squamous-cell NSCLC, nivolumab vs. docetaxel in nonsquamous-cell NSCLC and pembrolizumab vs. docetaxel were EUR132,248 (EUR113,483 - EUR156,045), EUR197,187 (EUR171,718 - EUR228,407) and EUR208,652 (EUR182,492 - EUR237,161) respectively (table 1). Treating only patients with PD-L1-positive tumors substantially reduced additional costs per QALY gained for nivolumab in nonsquamous-cell NSCLC and for pembrolizumab but the incremental cost-effectiveness ratio still considerably exceeded EUR100,000 per QALY. Figure 1
Conclusion:
PD1-inhibitors nivolumab and pembrolizumab are likely not cost-effective in previously treated patients with advanced NSCLC, even in patients with substantial PD-L1 expression, at current price levels in Germany.
