Department of Pharmacy, The Second Xiangya Hospital of Central South University, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China.
PET-CT Center, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
Adv Ther. 2021 Jul;38(7):3962-3972. doi: 10.1007/s12325-021-01788-6. Epub 2021 Jun 7.
The effectiveness of nivolumab plus ipilimumab with two cycles of chemotherapy (NIC) for advanced non-small cell lung cancer (NSCLC) has been demonstrated. We aimed to evaluate the cost-effectiveness of NIC for advanced NSCLC from the US payer perspective.
A Markov model has been established to predict the disease course of previously untreated advanced NSCLC. The clinical data were derived from the CheckMate 9LA trial. Cost and utility were obtained from the literature. Model outputs included the incremental cost-effectiveness ratios (ICERs), incremental monetary benefit (INMB), and incremental net-health benefit (INHB). A series of sensitivity analyses were performed to analyze the uncertainty of the model.
Our results showed that NIC versus chemotherapy alone cost $264,278 and yielded an additional 0.80 quality-adjusted life-years (QALYs), which led to an ICER of $202,275/QALY gained. The INHB was - 0.28 QALY, and the INMB was - $41,865 at the threshold of $150,000/QALY. The results of one-way sensitivity analysis showed that the hazard ratio of overall survival was the most sensitive parameter.
NIC was unlikely to be cost-effective as a first-line treatment for patients with advanced NSCLC.
纳武利尤单抗联合伊匹单抗加两个周期化疗（NIC）治疗晚期非小细胞肺癌（NSCLC）的疗效已得到证实。我们旨在从美国支付者的角度评估 NIC 治疗晚期 NSCLC 的成本效益。
建立了一个马尔可夫模型来预测未经治疗的晚期 NSCLC 的疾病进程。临床数据来自 CheckMate 9LA 试验。成本和效用来自文献。模型输出包括增量成本效益比（ICER）、增量货币收益（INMB）和增量净健康收益（INHB）。进行了一系列敏感性分析以分析模型的不确定性。
我们的结果表明，NIC 与单独化疗相比，成本为 264,278 美元，额外获得 0.80 个质量调整生命年（QALYs），导致每获得 1 个 QALY 的 ICER 为 202,275 美元。在 150,000 美元/QALY 的阈值下，INHB 为-0.28 QALY，INMB 为-41,865 美元。单因素敏感性分析的结果表明，总生存风险比是最敏感的参数。
NIC 不太可能成为晚期 NSCLC 患者一线治疗的经济有效选择。
