Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Level 3, Building BC, 221 Burwood Hwy, Burwood, VIC, 3125, Australia.
Global Obesity Centre, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, VIC, Australia.
Appl Health Econ Health Policy. 2019 Jun;17(3):371-380. doi: 10.1007/s40258-018-0452-0.
To assess the cost-effectiveness of nivolumab for patients with advanced or metastatic squamous non-small-cell lung cancer (NSCLC) progressed on or after platinum-based chemotherapy using a modelled economic evaluation.
Both partition survival (PS) and Markov models, comprised of three health states, were adopted to evaluate the cost-effectiveness of nivolumab compared to docetaxel from an Australian healthcare system perspective with a 6-year time horizon. Reconstructed individual patient data (IPD) were derived from published Kaplan-Meier curves from the pivotal trial for overall survival (OS) and progression-free survival (PFS) using a validated algorithm. Best-fitting survival curves were selected to extrapolate the OS, PFS and post-progression survival (PPS) beyond trial duration. Expected costs and health outcomes [i.e. quality-adjusted life year (QALY), and life year (LY)] associated with each of the health states (i.e. PF, PD and dead) were accrued over the time horizon. Both deterministic and probabilistic sensitivity analyses were undertaken.
Nivolumab was associated with both higher costs and benefits in both PS and Markov models. In particular, from the PS model, nivolumab cost an additional A$198,862/QALY and A$181,623/LY gained. The Markov model showed that nivolumab had an incremental cost-effectiveness ratio (ICER) of A$220,029/QALY and A$193,459/LY, respectively. The sensitivity analyses showed base-case results were sensitive to the extrapolation approach, duration of treatment, cost of nivolumab and time horizon modelled.
Using an often-quoted willingness-to-pay per QALY threshold in Australia (i.e. A$50,000), the treatment with nivolumab cannot be considered cost-effective. It might be funded publicly by special arrangements given unmet clinical needs for patients.
通过建模经济评估，评估纳武利尤单抗在铂类化疗后进展的晚期或转移性鳞状非小细胞肺癌（NSCLC）患者中的成本效益。
从澳大利亚医疗保健系统的角度出发，采用分区生存（PS）和马尔可夫模型（由三个健康状态组成），对纳武利尤单抗与多西他赛相比的成本效益进行评估，时间范围为 6 年。使用经过验证的算法，从关键试验的总体生存（OS）和无进展生存（PFS）的发表的 Kaplan-Meier 曲线中得出重建的个体患者数据（IPD）。选择最佳拟合的生存曲线来推断 OS、PFS 和进展后生存（PPS）超过试验持续时间。在时间范围内累积与每个健康状态（即 PF、PD 和死亡）相关的预期成本和健康结果[即质量调整生命年（QALY）和生命年（LY）]。进行了确定性和概率敏感性分析。
PS 和马尔可夫模型中，纳武利尤单抗均与更高的成本和效益相关。特别是从 PS 模型来看，纳武利尤单抗每增加一个 QALY 成本增加 198862 澳元，每增加一个 LY 成本增加 181623 澳元。马尔可夫模型显示，纳武利尤单抗的增量成本效益比（ICER）分别为每 QALY 220029 澳元和每 LY 193459 澳元。敏感性分析表明，基础案例结果对推断方法、治疗持续时间、纳武利尤单抗的成本和建模的时间范围敏感。
按照澳大利亚经常引用的每 QALY 意愿支付阈值（即 50000 澳元），纳武利尤单抗的治疗不能被认为是具有成本效益的。鉴于患者存在未满足的临床需求，可能会通过特殊安排由公共资金提供。
