Cost-effectiveness analysis of nivolumab plus ipilimumab plus two cycles of platinum-doublet chemotherapy versus platinum-doublet chemotherapy alone for first-line treatment of stage IV or recurrent non-small cell lung cancer in the United States

Abstract

Aim

This economic analysis evaluated the cost-effectiveness of nivolumab (NIVO) plus ipilimumab (IPI) plus two cycles of platinum-doublet chemotherapy (PDC) compared with four cycles of PDC as first-line treatment for patients with advanced NSCLC in the United States (US).

Methods

A partitioned survival model was constructed with three mutually exclusive health states: progression free, progressed disease, and death. The analysis was conducted from a US healthcare payer perspective, using a time horizon of 25 years. Costs and outcomes were discounted at 3% annually. Survival outcomes from CheckMate 9LA were extrapolated with longer follow-up data from CheckMate 227 Part 1 (NIVO + IPI) and validated against data from other relevant clinical trials and real-world registries. Health-related quality of life utility values were derived from EQ-5D-3L data collected in CheckMate 9LA. US-specific costs (2020 dollars) were used for disease management; drug acquisition, administration, and monitoring; end-of-life care; adverse events; and subsequent treatments. Model outcomes included life years (LYs) gained, quality-adjusted LYs (QALYs) gained, and incremental cost-effectiveness ratio (ICER) for NIVO + IPI + PDC versus PDC. Sensitivity and scenario analyses were conducted.

Results

NIVO + IPI + PDC was associated with higher projected health benefits than PDC, including gains in LYs (3.71 vs 1.89) and QALYs (2.86 vs 1.37), and higher costs ($317,581 vs $119,909). The ICER was $132,960/QALY gained. NIVO + IPI + PDC had a 78–100% probability of being cost-effective at a willingness-to-pay threshold of $150,000–$250,000/QALY. Sensitivity and scenario analyses indicated that the results were robust to changes in key parameters.

Limitations

The inherent limitation in extrapolating clinical trial data was mitigated using data from the more mature CheckMate 227 Part 1 trial and validating the outcomes against data from other relevant trials and real-world registries.

Conclusion

NIVO + IPI + PDC (two cycles) provides a new first-line treatment option for patients with advanced NSCLC that is cost-effective within a range considered acceptable in the US.

Keywords:

• Nivolumab
• ipilimumab
• cost-effectiveness
• NSCLC
• United States

JEL CLASSIFICATION CODES:

• H51
• H5
• H
• I11
• I1
• I

View addendum:

Cost-effectiveness analysis of nivolumab plus ipilimumab versus platinum-doublet chemotherapy for first-line treatment of stage IV or recurrent non-small cell lung cancer in the United States

Transparency

Declaration of funding

This study was funded by Bristol Myers Squibb.

Declaration of financial/other relationships

MP, HS, PD, and CJ were employees and JM is an employee of Parexel International, and were funded by Bristol Myers Squibb to conduct the analysis. YY, MAC, NV, AL, SJL, and JRP are employees of Bristol Myers Squibb.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors contributed to study conception and design, drafted the manuscript, and approved of the final version for submission. MP, HS, JM, PD, and CJ performed the analysis.

Acknowledgements

Editorial and medical writing support was provided by Simon Foulcer, PhD, CMPP, and Russ Craddock, PhD, of Parexel International and was funded by Bristol Myers Squibb.

Data availability statement

The analysis reported in this study uses patient-level data from the CheckMate 9LA trial and CheckMate 227 Part 1 data. The patient-level data are not publicly available, but the results of the trial have been reported in a number of publications.