University of Southern California, USC Schaeffer Center, 635 Downey Way, Los Angeles, CA 90089-3333. E-mail:
Am J Manag Care. 2017 Oct 1;23(10):e340-e346.
To develop a model of the option value a therapy provides by enabling patients to live to see subsequent innovations and to apply the model to the case of nivolumab in renal cell carcinoma (RCC) and non-small cell lung cancer (NSCLC).
A model of the option value of nivolumab in RCC and NSCLC was developed and estimated.
Data from the Surveillance, Epidemiology, and End Results (SEER) cancer registry and published clinical trial results were used to estimate survival curves for metastatic cancer patients with RCC, squamous NSCLC, or nonsquamous NSCLC. To estimate the conventional value of nivolumab, survival with the pre-nivolumab standard of care was compared with survival with nivolumab assuming no future innovation. To estimate the option value of nivolumab, long-term survival trends in RCC and squamous and nonsquamous NSCLC were measured in SEER to forecast mortality improvements that nivolumab patients may live to see.
Compared with the previous standard of care, nivolumab extended life expectancy by 6.3 months in RCC, 7.5 months in squamous NSCLC, and 4.5 months in nonsquamous NSCLC, according to conventional methods. Accounting for expected future mortality trends, nivolumab patients are likely to gain an additional 1.2 months in RCC, 0.4 months in squamous NSCLC, and 0.5 months in nonsquamous NSCLC. These option values correspond to 18%, 5%, and 10% of the conventional value of nivolumab, respectively.
Option value is important when valuing therapies like nivolumab that extend life in a rapidly evolving area of care.
通过使患者能够看到后续创新，从而为治疗提供一种选择价值的模型，并将该模型应用于肾细胞癌（RCC）和非小细胞肺癌（NSCLC）中的nivolumab 案例。
开发并评估了 RCC 和 NSCLC 中 nivolumab 的选择价值模型。
使用来自监测、流行病学和最终结果（SEER）癌症登记处和已发表的临床试验结果的数据，估计转移性 RCC、鳞状 NSCLC 或非鳞状 NSCLC 患者的生存曲线。为了估计 nivolumab 的常规价值，将使用 nivolumab 之前的标准护理的生存与假设没有未来创新的 nivolumab 生存进行比较。为了估计 nivolumab 的选择价值，在 SEER 中测量了 RCC 和鳞状及非鳞状 NSCLC 的长期生存趋势，以预测 nivolumab 患者可能会看到的死亡率改善。
根据常规方法，与之前的标准护理相比，nivolumab 在 RCC 中延长了 6.3 个月的预期寿命，在鳞状 NSCLC 中延长了 7.5 个月，在非鳞状 NSCLC 中延长了 4.5 个月。考虑到预期的未来死亡率趋势，nivolumab 患者在 RCC 中可能会额外获得 1.2 个月，在鳞状 NSCLC 中获得 0.4 个月，在非鳞状 NSCLC 中获得 0.5 个月。这些选择价值分别对应于 nivolumab 常规价值的 18%、5%和 10%。
当评估像 nivolumab 这样的治疗方法时，选择价值很重要，因为这些治疗方法在不断发展的治疗领域中延长了生命。
