Cost-effectiveness analysis of nivolumab for the treatment of squamous cell carcinoma of the head and neck in the United States

Figures & data

Figure 1. Schematic representation of partitioned survival model and disease health state transitions.

Table 1. Absolute value estimates of health outcomes and costs associated with each treatment in the model.

	Health outcomes			Costs ($)
	AE disutility	LYs	QALYs	Disease management	Treatment acquisition	Treatment administration	Treatment monitoring	AEs	Subsequent treatment	Total
Nivolumab	−0.04	1.21	0.89	20,816	75,981	1,661	275	1,977	842	101,552
Investigator’s choice	−0.07	0.68	0.42	16,316	14,599	2,057	72	3,800	1,222	38,067

Abbreviations. AEs, adverse events; ICER, incremental cost-effectiveness ratio; LY, life-years; QALYs, quality-adjusted life-years. All costs are in 2017 US$.

Table 2. Incremental gains with nivolumab vs investigator’s choice.

	LYs	QALYs	Costs ($)	Cost per LYG ($)	Cost per QALY ($)
Base case	0.54	0.47	63,485	118,455	134,438
Assuming increased subsequent use of immunotherapies	0.54	0.47	61,202	114,194	129,603
Removing disutilities associated with AEs from the model	0.54	0.45	63,482	118,455	141,806

Abbreviations. AEs, adverse events; FDA, US Food and Drug Administration; LY, life-years; LYG, life-years gained; QALYs, quality-adjusted life-years. All costs are in 2017 US$.

Figure 2. Deterministic sensitivity analysis of ICER response to variability of input parameters for nivolumab vs investigator’s choice arm. Abbreviations. ICER, incremental cost-effectiveness ratio; OS, overall survival; PD, progressed disease; PF, progression-free. Range of input variability: ±standard error for utility values; ±20% for all other inputs values.

Table 3. Probabilistic sensitivity analysis of health outcomes and costs associated with each treatment in 1,000 model iterations.

	Total costs ($)	Total QALYs	Incremental costs ($) vs IC	Incremental QALYs vs IC	Incremental cost per QALY ($)
IC	37,743	0.421	–	–	–
Nivolumab	102,974	0.894	65,231	0.473	137,927

Abbreviations. IC, Investigator’s choice; QALYs, quality-adjusted life-years. All costs are in 2017 US$. 62.2% of model iterations had an incremental cost per QALY of less than $150,000.