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. 2023 Mar;7(2):273-284.
doi: 10.1007/s41669-022-00383-x. Epub 2023 Mar 10.

Economic Evaluation of Nivolumab Versus Docetaxel for the Treatment of Advanced Squamous and Non-squamous Non-small Cell Lung Cancer After Prior Chemotherapy in China

Shanlian Hu  1 , Zhiliu Tang  2   3 , James P Harrison  4 , Nadine Hertel  5 , John R Penrod  4 , Jessica R May  5 , Ariadna Juarez-Garcia  5 , Orban Holdgate  6
Affiliations

Economic Evaluation of Nivolumab Versus Docetaxel for the Treatment of Advanced Squamous and Non-squamous Non-small Cell Lung Cancer After Prior Chemotherapy in China

Shanlian Hu et al. Pharmacoecon Open. 2023 Mar.

Abstract

Objective: To evaluate the economic value of nivolumab versus docetaxel for advanced non-small cell lung cancer (aNSCLC) treatment after platinum-based chemotherapy in adults without epidermal growth factor receptor/anaplastic lymphoma kinase aberrations in China.

Methods: Partitioned survival models evaluated lifetime costs and benefits of nivolumab versus docetaxel by squamous and non-squamous histologies from a Chinese healthcare payer perspective. Progression-free disease, progressed disease, and death health states were considered over a 20-year time horizon. Clinical data were derived from the CheckMate pivotal Phase III trials (ClinicalTrials.gov identifiers: NCT01642004, NCT01673867, NCT02613507); patient-level survival data were extrapolated using parametric functions. China-specific health state utilities, healthcare resource utilisation, and unit costs were applied. Sensitivity analyses explored uncertainty.

Results: Nivolumab resulted in extended survival (1.489 and 1.228 life-years [1.226 and 0.995 discounted]) and quality-adjusted survival benefits (1.034 and 0.833 quality-adjusted life-years) at additional costs of ¥214,353 (US$31,829) and ¥158,993 (US$23,608) versus docetaxel in squamous and non-squamous aNSCLC, respectively. Nivolumab was associated with higher acquisition costs, lower subsequent treatment costs, and lower adverse event management costs than docetaxel in both histologies. Drug acquisition costs, discount rate for outcomes, and average body weight were key model drivers. Stochastic results aligned with the deterministic results.

Conclusions: Nivolumab yielded survival and quality-adjusted survival benefits at incremental cost versus docetaxel in aNSCLC. As a traditional healthcare payer perspective was applied, the true economic benefit of nivolumab may be underestimated as not all treatment benefits and costs of relevance to society were considered.

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Conflict of interest statement

S. Hu is a Health Economics Professor employed by the School of Public Health, Fudan University. Z. Tang was an employee of Sino-American Shanghai Squibb Pharmaceuticals Ltd at the time the work was undertaken. J.P. Harrison, N. Hertel, J.R. Penrod, J.R. May, and A. Juarez-Garcia are employees of Bristol Myers Squibb and report stock ownership in Bristol Myers Squibb. O. Holdgate was an employee of Parexel International at the time the work was undertaken.

Figures

Fig. 1
Fig. 1
Deterministic sensitivity analysis in (a) squamous aNSCLC and (b) non-squamous aNSCLC. The results for body weight reflect the effect of vial sharing. Only an increase or decrease in weight sufficient to need a new vial of nivolumab or docetaxel (calculated via body surface area) would have an impact on the results. For average patient body weight, there is no bar for lower parameter value because the reduction in patient weight used in the sensitivity analysis did not lead to a change in vial calculations for nivolumab and therefore the ICER was unaffected. admin. administration, aNSCLC advanced non-small cell lung cancer, avg. average, ICER incremental cost-effectiveness ratio, PD progressed disease, PF progression-free, sub. subsequent
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