Chaudhary Mohammad A, Lubinga Solomon J, Smare Caitlin, Hertel Nadine, Penrod John R
Bristol Myers Squibb, 3401 Princeton Pike, Lawrence Township, NJ 08648. Email:
Am J Manag Care. 2021 Aug 1;27(8):e254-e260. doi: 10.37765/ajmc.2021.88726.
To determine the lifetime cost-effectiveness of nivolumab vs docetaxel in advanced squamous and nonsquamous non-small cell lung cancer (NSCLC) following platinum-based chemotherapy from a US payer perspective.
Trial- and cohort-based cost-effectiveness analyses.
The analyses used partitioned survival models with 3 mutually exclusive health states: progression free, progressed disease, and death. The mean starting age was 61 years. Clinical parameters were derived from the 2 registrational, randomized, phase 3 trials with a minimum follow-up of 5 years. Costs were derived from published literature. The primary outcomes were quality-adjusted life-years (QALYs), life-years gained (LYG), and incremental cost-effectiveness ratios (ICERs). Costs and outcomes were discounted at 3% per annum. Uncertainty was examined using univariate and probabilistic sensitivity analyses.
In patients with squamous NSCLC, the use of nivolumab improved life-years (LYs) and QALYs by 1.23 and 0.99, respectively, compared with docetaxel. Costs were increased by $99,677, resulting in ICERs of $100,776 per QALY and $81,294 per LYG. In patients with nonsquamous NSCLC, nivolumab increased LYs and QALYs by 0.99 and 0.80, respectively. Costs were increased by $94,174, resulting in ICERs of $117,739 per QALY and $94,849 per LYG. ICERs were most sensitive to the discount rates applied to costs and outcomes. At a willingness-to-pay threshold of $150,000, nivolumab had probabilities of 91% and 99% of being cost-effective in patients with squamous and nonsquamous NSCLC, respectively.
Nivolumab is likely to be cost-effective for the treatment of patients with advanced NSCLC following platinum-based chemotherapy in the United States.
从美国医保支付方的角度，确定纳武利尤单抗与多西他赛相比，在铂类化疗后的晚期鳞状和非鳞状非小细胞肺癌（NSCLC）中的终生成本效益。
基于试验和队列的成本效益分析。
分析采用具有3种相互排斥健康状态的分割生存模型：无进展、疾病进展和死亡。平均起始年龄为61岁。临床参数来自2项注册的、随机的3期试验，最短随访期为5年。成本来自已发表的文献。主要结局为质量调整生命年（QALY）、获得的生命年（LYG）和增量成本效益比（ICER）。成本和结局按每年3%进行贴现。使用单因素和概率敏感性分析来检验不确定性。
在鳞状NSCLC患者中，与多西他赛相比，使用纳武利尤单抗分别使生命年（LY）和QALY提高了1.23和0.99。成本增加了99,677美元，导致每QALY的ICER为100,776美元，每LYG的ICER为81,294美元。在非鳞状NSCLC患者中，纳武利尤单抗分别使LY和QALY提高了0.99和0.80。成本增加了94,174美元，导致每QALY的ICER为117,739美元，每LYG的ICER为94,849美元。ICER对应用于成本和结局的贴现率最为敏感。在支付意愿阈值为150,000美元时，纳武利尤单抗在鳞状和非鳞状NSCLC患者中具有成本效益的概率分别为91%和99%。
在美国，纳武利尤单抗在铂类化疗后的晚期NSCLC患者治疗中可能具有成本效益。
