A cost-effectiveness analysis of nivolumab versus docetaxel for advanced non-squamous non-small cell lung cancer including PD-L1 testing
Menée en Suisse, cette étude compare le rapport coût-efficacité du nivolumab et du docétaxel pour traiter les patients atteints d'un cancer du poumon non à petites cellules non épidermoïde de stade avancé, en prenant en compte le recours au test de l'expression de PD-L1 pour sélectionner les patients
Background : Nivolumab (NIV) was recently approved in several countries for patients with pre-treated advanced non-small cell lung cancer (NSCLC). NIV is not cost-effective compared to docetaxel (DOC) for the treatment of squamous NSCLC. However, its cost-effectiveness for non-squamous NSCLC and the consequences of PD-L1 testing are unknown. Methods : This literature-based health economic study used CheckMate-057 trial data to model the incremental cost-effectiveness ratio (ICER) of NIV versus DOC in the Swiss healthcare setting. The effect of PD-L1 positivity for patient selection was assessed. Results : In the base case model, NIV (mean costs CHF66,208; mean effect 0.69 QALYs) compared to DOC (mean costs CHF37,618; mean effect 0.53 QALYs) resulted in an ICER of CHF177,478/QALY gained. Treating only patients with PD-L1-positive tumours (threshold ≥10%) with NIV compared to treating all patients with DOC produced a base case ICER of CHF124,891/QALY gained. Reduced drug price, dose, or treatment duration reduced the ICER partly below a willingness-to-pay threshold of CHF100,000/QALY. Health state utilities strongly influenced cost-effectiveness. Conclusions : NIV compared to DOC is not cost-effective for the treatment of non-squamous NSCLC at current prices in the Swiss healthcare setting. Price reduction, or PD-L1 testing and selection of patients for NIV based on test positivity, improves cost-effectiveness compared to DOC.