Parexel International, Stockholm, Sweden.
Bristol Myers Squibb, Princeton, NJ, USA.
J Med Econ. 2022 Jan-Dec;25(1):703-711. doi: 10.1080/13696998.2022.2077549.
We evaluated the cost-effectiveness of nivolumab in combination with ipilimumab (NIVO + IPI) versus platinum-doublet chemotherapy (PDC) for the first-line treatment of stage IV or recurrent non-small cell lung cancer (NSCLC) from a third-party payer perspective in the United States (US).
A partitioned survival model was developed using efficacy, safety, and utility inputs derived from Part 1 of the phase 3 CheckMate 227 trial (NCT02477826) with 37.7-month minimum follow-up for overall survival (OS). OS and progression-free (PF) survival were extrapolated over a 20-year time-horizon using parametric spline-based models selected based on goodness of fit and validated with data from external sources. Duration of treatment Kaplan-Meier curves were used for treatment cost calculations. US-specific costs (2021 dollars) for drug acquisition, administration, and monitoring; disease management (PF and progressed disease health states); end-of-life care; adverse events; and subsequent treatments were derived from publicly available sources. Time-to-death utilities were applied in the base case, whereas treatment-specific progression-based utilities were tested in a scenario analysis. Main outcomes included incremental cost per life-year gained (LYG) and quality-adjusted life-year (QALY). Model uncertainty was assessed through deterministic and probabilistic sensitivity analyses.
NIVO + IPI resulted in 1.53 additional life-years, 1.33 additional QALYs, and $142 088 in additional costs compared with PDC. The incremental cost per LYG was $92 651, whereas incremental cost per QALY gained was $106 553. The application of treatment-specific progression-based utilities yielded an incremental cost per QALY gained of $117 076. Probabilistic sensitivity analysis revealed a 98% probability that NIVO + IPI was cost-effective versus PDC at a willingness-to-pay threshold of $150 000 per QALY.
NIVO + IPI was estimated to be cost-effective as a first-line treatment for stage IV or recurrent NSCLC in the US, with increased survival and higher cost compared with PDC.
我们从第三方支付者的角度评估了纳武利尤单抗联合伊匹单抗（NIVO+IPI）与铂类双药化疗（PDC）用于美国（US）IV 期或复发性非小细胞肺癌（NSCLC）一线治疗的成本效益。
采用来自 III 期 CheckMate 227 试验（NCT02477826）的疗效、安全性和效用输入，建立了分区生存模型，该试验的总体生存（OS）的最小随访时间为 37.7 个月。使用基于参数样条的模型对 OS 和无进展（PF）生存进行了 20 年的外推，这些模型是根据拟合优度选择的，并使用来自外部来源的数据进行了验证。使用治疗成本计算的治疗持续时间 Kaplan-Meier 曲线。药物获取、管理和监测；疾病管理（PF 和进展疾病健康状态）；临终关怀；不良事件；以及后续治疗的美国特定成本（2021 美元）来自公开来源。在基础情况下应用死亡时间效用，在方案分析中测试特定治疗的基于进展的效用。主要结果包括每获得一个生命年（LYG）的增量成本和质量调整生命年（QALY）。通过确定性和概率敏感性分析评估模型不确定性。
与 PDC 相比，NIVO+IPI 导致额外的 1.53 个生命年、1.33 个额外 QALYs 和额外 142088 美元的成本。每获得一个 LYG 的增量成本为 92651 美元，而获得一个 QALY 的增量成本为 106553 美元。应用特定治疗的基于进展的效用导致每获得一个 QALY 的增量成本为 117076 美元。概率敏感性分析表明，NIVO+IPI 比 PDC 在 150000 美元/QALY 的意愿支付阈值下更具成本效益的概率为 98%。
NIVO+IPI 被估计为美国 IV 期或复发性 NSCLC 的一线治疗具有成本效益，与 PDC 相比，它具有更高的生存获益和更高的成本。
