Cost-effectiveness of nivolumab versus surveillance for the adjuvant treatment of patients with urothelial carcinoma who are at high risk of recurrence: a US payer perspective

Figures & data

Figure 1. Model overview. Abbreviations. DF, disease-free; DR, distant recurrence; LR, local recurrence; P(Death|DF), probability of death from DF; P(Death|LR), probability of death from LR; P(DF|DF), probability of staying in DF; P(DR|DF), probability of moving from DF to DR; P(DR|LR), probability of moving from LR to DR; P(LR|DF), probability of moving from DF to LR; P(LR|LR), probability of staying in LR.

Note: DR_{1 to n} indicates model’s ability to track the time of entrance to the DR state via series of tunnel states, which are needed for the application of probability distributions with an underlying time-variant hazard structure.

Figure 2. Smoothed hazard plots of CheckMate 274 DFS with EORTC 30994 (2015) DFS and general population mortality up to 10 years. Abbreviation. DFS, disease-free survival. General population mortality rates are US specific and adjusted according to baseline age and sex distributions in the studies.

Figure 3. Reported DFS KM curves from the ITT population in CheckMate 274 and from the deferred chemotherapy arm of the EORTC-30994 trial, and long-term DFS extrapolations for nivolumab and placebo. Abbreviations. DFS, disease-free survival; ITT, intention to treat; KM, Kaplan–Meier.

Table 1. Base-case results (costs and health outcomes, discounted).

	Nivolumab	Surveillance
Total costs^a	$162 268	$62 965
Drug acquisition	$121 584	−
Drug administration	$2 234	−
Monitoring	$504	−
Disease management	$15 580	$13 389
Subsequent treatment	$12 800	$39 901
Surgery and radiotherapy	$69	$46
Terminal care	$9 159	$9 629
Adverse events	$340	−
Total QALYs	5.90	4.96
DF state	5.05	4.01
LR state	0.27	0.31
DR state	0.58	0.64
Total LYs	9.13	7.60
DF state	7.88	6.24
LR state	0.37	0.42
DR state	0.87	0.94
ICER		$64 929
ICUR		$105 660

Abbreviations. DF, disease free; DR, distant recurrence; ICER, incremental cost- effectiveness ratio; ICUR, incremental cost-utility ratio; LR, local recurrence; LY, life-year; QALY, quality-adjusted LY.

Bold highlight the total values

^aCosts and outcomes of adverse events were negligible and therefore not included in the table.

Note: Due to rounding, the sum of the numbers presented in this table may not precisely match the total sum indicated. All values have been rounded to 2 decimals, which may account for minor discrepancies in the final sum.

Figure 4. Summary of one-way deterministic sensitivity analysis with respect to 10 most influential parameters of the model. Abbreviations. 1 L, first line; Carb, carboplatin; DF, disease free; DFS, disease-free survival; Gem, gemcitabine; ICUR, incremental cost-utility ratio; HR, hazard ratio; OS, overall survival; QALY, quality-adjusted life-year. ^aRange tested 0–6%; ^brange tested based on reported or estimated standard error; ^crange tested based on estimated ±20% base-case value.

Figure 5. Cost-effectiveness acceptability curve. Abbreviation. WTP, willingness to pay.

Table 2. Results from scenario analyses.

Source/setting	ICER	% Change in ICER^a	ICUR	% Change in ICUR^a
Base case	$64 929		$105 660
3–health-state model	$58 884	−9	$95 709	−9
One-off costs and outcomes applied to DR health state (absorbing health states)	$64 802	0	$105 453	0
Linearly declining proportion of recurrence being first DFS event	$66 385	2	$108 322	3
LR survival modeled with log-normal	$67 334	4	$109 131	3
Timepoint for functional cure
4 years	$62 978	−3	$102 770	−3
10 years	$65 784	1	$107 051	1
Real-world evidence-based subsequent treatment distribution {Geynisman, 2022 #23}	$83 157	28	$133 854	27

Abbreviations. DFS, disease-free survival; DR, distant recurrence; ICER, incremental cost-effectiveness ratio; ICUR, incremental cost-utility ratio; LR, local recurrence.

Bold highlight the total values

^aFrom base case.

Data availability statement

Data are available upon reasonable request. Bristol Myers Squibb’s policy on data sharing may be found online at https://www.bms.com/researchers-and-partners/independent-research/data-sharing-request-process.html.